Intracranial subdural hematoma following dural puncture in a parturient with HELLP syndrome.

Purpose: To present a case of postpartum bilateral intracranial subdural hematoma after dural puncture during attempted epidural analgesia for labour.

Clinical Features: This complication occurred following accidental dural puncture in a parturient with thrombocytopenia (99,000 x microL-1) who subsequently developed the syndrome of hemolysis, elevated liver enzymes and low platelets. On the first postoperative day, postdural puncture headache (PDPH) developed.

Etiology and incidence of endotracheal intubation following spinal anesthesia for cesarean section.

Background: The incidence of spinal failure necessitating general anesthesia and endotracheal intubation following spinal anesthesia for cesarean section is extremely low. Aspiration prophylaxis prior to spinal anesthesia is often recommended in case of spinal failure or excessive spinal block requiring the emergency administration of general anesthesia.

Objectives: To determine the incidence of endotracheal intubation following spinal anesthesia for cesarean section.

Addition of dextrose 3.5% to intrathecal sufentanil for labour analgesia reduces pruritus.

Purpose: To determine whether the addition of a low concentration (3.5%) of dextrose would minimize pruritus while maintaining the quality of analgesia.

Methods: In a double blind study 48 parturients in early labour were randomized to one of two study groups: dextrose (Dex, n = 24; 10 microg sufentanil in dextrose 3.

Ondansetron versus placebo for the control of nausea and vomiting during Caesarean section under spinal anaesthesia.

This prospective, randomised, placebo-controlled, double-blind study was performed to evaluate the effects of ondansetron on nausea and vomiting during elective Caesarean section under spinal anaesthesia. Seventy-four full-term parturients were studied. After umbilical-cord clamping, ondansetron 4 mg or 0.

Rapacuronium for modified rapid sequence induction in elective caesarean section: neuromuscular blocking effects and safety compared with succinylcholine, and placental transfer.

We have compared rapacuronium 2.5 mg kg-1 (n = 20) with succinylcholine 1.5 mg kg-1 (n = 22) in a multicentre, blinded, randomized study in full-term parturients undergoing elective Caesarean section under general anaesthesia.

Combined spinal and epidural anesthesia for cesarean section in a parturient with moyamoya disease.

We present the case of a parturient with moyamoya disease admitted to the hospital for elective cesarean section. Combined spinal and epidural technique was chosen because it allows better analgesia than epidural anesthesia and more hemodynamic stability than either general or spinal anesthesia. Ropivacaine was the local anesthetic of choice for the epidural portion because of the wide sensory-motor dissociation, thus preserving adequate respiration in the case of a high block.

Ropivacaine-induced seizure after extradural anaesthesia.

Ropivacaine is considered safer than bupivacaine, on the basis of experimental and human data that indicate a lower systemic toxicity. Here we report the occurrence of a single seizure after i.v.

Heparinase-guided thrombelastography in an anticoagulated parturient.

We describe the use of heparinase-guided thrombelastography in the assessment of a parturient who had been anticoagulated with heparin for suspected thromboembolic disease. Reversal of the heparin effect in the heparinase-treated sample facilitated administration of protamine and successful subarachnoid analgesia for delivery.

Fetal heart rate changes after intrathecal sufentanil or epidural bupivacaine for labor analgesia: incidence and clinical significance.

The objective of this study was to compare the incidence of intrapartum fetal heart tracing (FHT) abnormalities and the obstetric outcome after intrathecal sufentanil (ITS) versus epidural bupivacaine (EB). During the period from April to September 1994, 129 patients who met inclusion criteria were prospectively identified during labor at a single university-affiliated hospital. Inclusion criteria included: singleton, gestational age > or = 36 wk, and cephalic presentation.

Effect of epidural analgesia on fundal dominance during spontaneous active-phase nulliparous labor.

Background: The purpose of this investigation was to determine if epidural analgesia, established during active phase labor, results in elimination or reversal of fundal dominance (lower uterine segment pressure equal to or greater than fundal pressure).

Methods: Upper and lower uterine segment intrauterine pressures were prospectively evaluated for 50 min before and 50 min after epidural analgesia using 0.25% bupivacaine in 11 nulliparous women in spontaneous active labor.

Anaesthetic management of acute puerperal uterine inversion.

We identified 18 cases of acute puerperal uterine inversion after vaginal delivery out of 65,581 deliveries in two university-affiliated hospitals (an incidence of 1:3643). In all cases manual repositioning of the uterus without tocolysis was attempted. In four cases this was successful.

Rocuronium (Org 9426) for caesarean section.

This was a prospective, non-randomized, multicentre study of rocuronium (Org 9426) in 40 elective Caesarean section patients at full term without fetal distress. Anaesthesia was induced with thiopentone 4-6 mg kg-1 i.v.

Combined spinal-epidural analgesia in advanced labour.

The combined spinal-epidural technique is a modification of epidural analgesia which combines the rapid onset of spinal analgesia with the flexibility of an epidural catheter. We sought to evaluate the effectiveness of an intrathecal opioid--low-dose local anaesthetic combination for parturients in advanced labour, a setting where satisfactory epidural analgesia is often difficult to achieve. The technique was evaluated in an open-label, non-randomized trial using parturients in advanced, active labour for the provision of pain relief during the late first stage and second stage of labour.