Anaesthesia For Emergency Caesarean Section Research Articles

Spinal anaesthesia for emergency caesarean section in a parturient with acute subarachnoid haemorrhage

administered with hyperbaric bupivacaine 0.5%, 2.3 ml and fentanyl 15 mcg. Surgery proceeded uneventfully, patient remained haemodynamically stable and anaesthesia recovery was uncomplicated. Postoperative pain was managed with oral paracetamol, mefenamic acid and patient-controlled intravenous morphine. Satisfaction for anaesthesia was found to be high due to good maternal and foetal outcome. Discussion General anaesthesia for Caesarean section in patients with intracranial haemorrhage has been described. However, because of the rarity of the condition, there is no consensus with regards to optimal anaesthetic care. Despite the numerous advantages that spinal anaesthesia can offer, the authors did not find any precedent reports in the literature. In addition to the known risks of the spinal anaesthesia, post-duralpuncture headache (PDPH) may be difficult to diagnose in a patient with existing headaches. Practitioners are required to remain vigilant, because worsening headache, due to PDPH, may confound the evaluation of re-bleed in intracranial aneurysm. Conclusion In a patient, with recent SAH and minimal neurological deficit undergoing emergency Caesarean section, spinal anaesthesia should be considered, as it has multiple advantages.

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Spinal anesthesia for emergency cesarean section in a preeclampsia patient diagnosed with type 1 neurofibromatosis

Spinal anesthesia for emergency cesarean section in a preeclampsia patient diagnosed with type 1 neurofibromatosis

Anesthesia for Emergency Cesarean Section in a Parturient with Noonan Syndrome

Patients with Noonan syndrome are characterized by many anesthetic problems, primarily related to potential difficult airway and technical issues with regional anesthesia. We describe the anesthetic management of a difficult case of a parturient with Noonan syndrome requiring emergency Cesarean section under spinal anesthesia. We had to evaluate the patient within a limited amount of time because of fetal distress. Although spinal injection was easily accomplished, it resulted in inadequate sensory block requiring supplemental analgesics and sedatives.

Spinal Anaesthesia for Emergency Caesarean Section in a Morbid Obese Woman with Severe Preeclampsia

Background. Morbid obesity in a pregnancy is a great challenge to medical practice especially when the patient requires caesarean section. Case Summary. A 38-year-old unbooked gravida 3 Para 2+0 weight 195 kg, height 1.7 m with a blood pressure of 210/160 mmhg had spinal anaesthesia for emergency caesarean section which was technically difficult for severe preeclampsia at 32-week gestation. She had poor wound healing and spent 18 days postoperatively on hospital admission. Conclusion. Morbid obesity is a challenge to both obstetric and anaesthetic practice. Antenatal care is necessary in reducing both maternal morbidity and mortality.

Parturient with kyphoscoliosis (operated) for cesarean section

Anesthesia for emergency cesarean section for the pregnant patient with surgically corrected scoliosis is associated with potential risks for both mother and the fetus due to alterations in maternal physiology and the pathological changes seen in scoliosis. The anesthetic management must address the well being of both mother and fetus. The need for anesthesia for obstetric delivery in pregnant women with scoliosis is much more than in the normal parturient. We report the successful use of spinal anesthesia in a patient with surgically corrected scoliosis for emergency cesarean section.

Anaesthesia for emergency Caesarean section in a patient with peripartum cardiomypathy

Peripartum cardiomyopathy (PPCM) is defined as the onset of acute heart failure without demonstrable cause in the last trimester of pregnancy or within the first six months after delivery. We report a case of PPCM (LVEF < 39%) in a 30-year-old housekeeper requiring emergency Caesarean section, who was successfully managed with combined spinal-epidural anesthesia, using low-dose fentanyl for the spinal anesthesia.

Estimation of the dose of hyperbaric bupivacaine for spinal anaesthesia for emergency caesarean section in an achondroplastic dwarf

Estimation of the dose of hyperbaric bupivacaine for spinal anaesthesia for emergency caesarean section in an achondroplastic dwarf

Anaesthesia for Emergency Caesarean Section in a Patient with Large Anterior Mediastinal Tumour Presenting as Intrathoracic Airway Compression and Superior Vena Cava Obstruction

Anterior mediastinal mass is an uncommon pathology that presents significant anaesthetic challenges because of cardiopulmonary compromise. We present a case that presented in the third trimester of pregnancy with severe breathlessness, orthopnoea, and symptoms of superior vena cava obstruction. The patient had emergency Caesarean section under epidural anaesthesia with a good outcome. The paper discusses the relevant perioperative considerations for this complex scenario and reviews reports of similar conditions.

Respiratory insufficiency in a patient with preeclamsia and hypothyroidism developed after general anesthesia for emergency cesarean section: A case report.

Anesthesia and surgery in a patients with undiagnosed or untreated hypothyroidism can carries the risk of potential complications such as prolonged unconsciousness, respiratory insufficiency, hypotension, hyponatremia, congestive heart failure, and even coma. A 33-year-old gravida was admitted at 36 weeks gestation with hypertension, proteinuria, generalized edema, and intrauterine fetal growth retardation. She had thyroidectomy for thyroid mass six years ago. Because of doubt of uterine abruption, emergency cesarean section was performed without result of thyroid function test. Preeclamsia and mild hypothyroidism show similar symptoms and it can make difficult to diagnose hypothyroidism. We experienced delayed recovery and respiratory insufficiency in a patient with preeclamsia and undetected hypothyroidism during emergence from general anesthesia. She was fully recovered after ventilatory care in intensive care unit.

Epidural lidocaine‐bicarbonate‐adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial*

Epidural mixtures containing lidocaine with or without additives are commonly used to convert epidural analgesia in labour to anaesthesia for emergency Caesarean section, but direct comparisons with alternative, single agents in this situation are few. In a prospective double-blinded trial, we compared a freshly prepared lidocaine-bicarbonate-adrenaline mixture (final concentrations 1.8%, 0.76% and 1:200,000, respectively) with our standard agent, levobupivacaine 0.5%, for extending epidural blockade for emergency Caesarean section. Using a sequential analysis technique, with data analysed in blocks of 40, women receiving epidural analgesia in labour who required top-up for Caesarean section were randomly assigned to receive 20 ml of epidural solution over 3 min. The first analysis (n = 40) indicated that the study should be stopped, as significant differences were found in our primary outcome data. Median (IQR [range]) times to reach a block to touch to T5 and cold to T4 were, respectively, 7 (6-9 [5-17]) min and 7 (5-8 [4-17]) min for lidocaine-bicarbonate-adrenaline, and 14 (10 -17 [9-31]) min and 11 (9-14 [6-30]) min for levobupivacaine (p = 0.00004 and 0.001, respectively). Pre- and intra-operative supplementation/pain, maternal side-effects and neonatal outcomes (excluding five women who underwent instrumental delivery) were similar between the groups. Intra-operative maternal sedation (scored by the mother on a 10-point scale) was greater with lidocaine-bicarbonate-adrenaline (4.5 (3-8 [1-9])) than with levobupivacaine (3 (1-4 [1-7])), but not significantly so (p = 0.07). We conclude that epidural lidocaine-bicarbonate-adrenaline halves the onset time when extending epidural analgesia for Caesarean section although there is a possibility of increased maternal sedation.

The extension of epidural blockade for emergency Caesarean section: a survey of current UK practice*

The conversion of epidural analgesia during labour to surgical anaesthesia for Caesarean section can have important medical and medicolegal implications. This survey sought to establish the current management for extending epidural blockade for emergency Caesarean section. A postal questionnaire was sent to the lead obstetric anaesthetist in all maternity units in the UK (n = 254). The response rate was 82% (n = 209). Of those surveyed, 68% (136) give the full dose of the local anaesthetic mixture in the delivery room, whilst 12.5% (25) initiate the top-up in the delivery room and give the remainder of the dose in theatre. Fifteen per cent (30) transfer the woman to theatre before commencing anaesthesia and 34% (68) give a test dose before the full anaesthetic dose. Guidelines for converting labour analgesia to anaesthesia for emergency Caesarean section were available in 64% (128) units. Bupivacaine 0.5% was the most commonly used agent, being used as the sole agent by 41.5% (81) units and in combination by a further 18% (36). Adrenaline was added to the chosen local anaesthetic by 30% (60) whilst 12% (24) added bicarbonate. In all, 13 combinations of local anaesthetics and adjuncts were used. The mode time to transfer the patient to theatre was 1 min. Of the 161 respondents who commenced anaesthesia in the delivery room, 71% (114) did not monitor the patient during transfer, whilst 87% (140) had ephedrine immediately available. Thirty-three respondents reported a total of 43 adverse incidents associated with the extension of epidural blockade. These included high blocks, inadequate blocks and possible intravascular injections, the latter resulting in two seizures and one cardiac arrest.

The Use of Remifentanil during General Anesthesia for Emergency Cesarean Section in a Patient with HELLP Syndrome - A case report -

HELLP syndrome (Hemolysis, Elevated Liver enzymes, and a Low Platelet count) is a severe complication of preeclampsia or eclampsia, and is associated with a high risk of maternal and neonatal morbidity and mortality. In cases of delivery management in patients with HELLP syndrome, general anesthesia is required for cesarean sections in the presence of severe thrombocytopenia. These patients have a high risk of uncontrollable hypertension under stressful conditions, such as laryngoscopic intubation, surgical incision, and delivery. Remifentanil is an ultra-short-acting opioid with rapid onset and offset of action. In addition, remifentanil has a potent analgesic effect and provides cardiovascular stability during surgery. This paper reports a 33-year-old patient with HELLP syndrome, who was referred to our hospital for a cesarean section. The procedure was performed under general anesthesia with remifentanil being used as an adjunct for cardiovascular stability.

Use of remifentanil in general anesthesia for emergency cesarean section in a patient with severe valvular heart disease and pulmonary hypertension

Use of remifentanil in general anesthesia for emergency cesarean section in a patient with severe valvular heart disease and pulmonary hypertension

Spinal anaesthesia for emergency Caesarean section in an achondroplastic patient

Spinal anaesthesia for emergency Caesarean section in an achondroplastic patient

Anaesthetic management of a woman with autosomal recessive limb-girdle muscular dystrophy for emergency caesarean section

We report the successful management of a 28-year-old parturient with an autosomal recessive limb-girdle muscular dystrophy with severe restrictive lung disease, who required non-invasive positive pressure ventilation in the third trimester of her pregnancy. At 37 weeks' gestation she had combined spinal-epidural anaesthesia for emergency caesarean section and had an uncomplicated intra- and postoperative course. The anaesthetic management is discussed and the literature briefly reviewed.

Phaeochromocytoma Causing Acute Pulmonary Oedema during Emergency Caesarean Section

We report a case of severe acute pulmonary oedema following induction of general anaesthesia for emergency caesarean section. After several hours of aggressive resuscitation, both mother and child had a favourable outcome. Postoperative investigation of acute renal failure demonstrated a supra-adrenal mass. Further investigation confirmed bilateral phaeochromocytoma as the cause of her condition. A literature review confirmed this to be a rare but important clinical entity, owing to its high mortality. Antenatal diagnosis greatly improves survival. Magnesium sulphate appears to be a useful and safe agent to employ in cases of undiagnosed hypertensive obstetric emergencies.

Randomized double-blinded comparison of phenylephrine versus ephedrine for treating hypotension during spinal anaesthesia for emergency Caesarean section

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China

Anaesthesia for Emergency Caesarean Section, 2000-2004, at the Royal Women's Hospital, Melbourne

The provision of anaesthesia for emergency caesarean section is a major part of the workload of obstetric anaesthetists and the urgency often dictates the mode of anaesthesia that can be provided. We have audited the provision of anaesthesia for 'immediate' caesarean sections over a four-year period following the introduction of a 'Code Green' system to coordinate a rapid response to an obstetric decision to proceed with an 'immediate' caesarean section. The records of all patients for whom a Code Green was called between July 2000 and June 2004 were studied. The reasons for the call, interval timings (for example decision-to-delivery interval) and type of anaesthesia used were collected. There were 444 Code Green procedures, of which 47 were excluded due to incomplete data. The most common indication was fetal distress' and the three most common types of anaesthesia used were general (n = 206), Epidural top-up (n = 106) and spinal (n = 65). Mean decision-to-delivery intervals (+/- SD) for all caesarean sections were 17 (+/- 6) minutes with general anaesthesia, 19 (+/- 9) minutes with epidural and 26 (+/- 9) minutes with spinal anaesthesia. Forty-five percent of calls were made between the hours of 0700 and 1700 h. General anaesthesia was most used between the hours of 0700 and 1700 h. A swift response to the call for an immediate caesarean section can be achieved when suitable facilities and procedures are in place. Administering an epidural bolus into an already established epidural catheter that is working effectively can allow a decision-to-delivery interval almost as short as general anaesthesia.

A response to ‘Obesity and obstetric anaesthesia’

In their otherwise comprehensive review on obesity and obstetric anaesthesia, Saravanakumar et al. [1] omit some important points. They refer to the prevalence of obesity in women of childbearing age. Perhaps more relevant is the prevalence of obesity in women requiring anaesthetic intervention on the labour ward. Two recent reports indicate that this ranges from 7.5% (women with BMI of 35 kg.m−2 or more) [2] to 15% (women with BMI of 30 kg.m−2 or more) [3]. A local audit of 1096 such women shows that almost 40% were either overweight or obese (unpublished data). With regard to the technical difficulties with regional techniques in obese parturients, we found, as expected, a significant increase in difficulties establishing epidural analgesia, but no increase in the requirement for re-siting or in the failure of the epidural to provide satisfactory surgical anaesthesia for emergency Caesarean section in labour compared with non-obese women. Although the depth to the epidural space is correlated with BMI (as stated in the review), it is a poor correlation and of limited predictive value. We found r = 0.4, Stockton et al. found r = 0.3 [4], and Watts also reported a poor correlation [5]. In discussing the relative merits of the sitting position for performing regional techniques in obese women, the authors omit to mention that there is a significant increase in the incidence of unwanted epidural venous cannulation in this position when compared with the head-down, lateral position, presumably due to reduced epidural venous distension [6]. Finally, there is no mention of the technique of local infiltration anaesthesia for Caesarean section in obese parturients which has been reported in the literature [7]. Exceptionally, this technique might be useful in the event of maternal collapse or if in extremis general and regional anaesthesia are considered contra-indicated. It is perhaps a skill that trainee obstetricians should revisit. We currently have on our staff an obstetrician from Sudan who has considerable experience of this technique.