Dirk Younker

Maternal cortical vein thrombosis and the obstetric anesthesiologist.

: Maternal cortical vein thrombosis is a potentially fatal complication of pregnancy and the puerperium. Patients may present with focal neurologic deficits, seizures, or symptoms indicating increased intracranial pressure. Associated conditions include maternal dehydration and preeclampsia or frank eclampsia. Parturients may require anesthesia for various types of delivery. Safe administration of appropriate anesthesia must take into account the possible presence of a coagulopathy or reduced intracranial compliance. Case presentations, a literature review, possible pathogenetic mechanisms, and specific anesthetic considerations are discussed to enable the obstetric anesthesiologist to develop a rational plan of management.

Bupivicaine-fentanyl epidural analgesia for a parturient in status asthmaticus

Regional anaesthesia is a suitable technique for the management of the asthmatic parturient. We report the case of an asthmatic gravida in labour in whom prompt institution of bupivicaine-fentanyl epidural analgesia was associated with enhancement of the effectiveness of concurrent medical therapy for bronchospasm. Prior to the initiation of epidural blockade, inhaled atropine was employed in an effort to reduce parasympathetic tone in the bronchial smooth muscle. Sustained clinical improvement did not occur until after delivery of the fetus and placenta.RésuméĽanesthésie régionale est une technique convenable pour traiter une parturiente asthmatique. Nous rapportons le cas ďune asthmatique en travail chez qui ľadministration rapide ďune analgésie péridurale au bupivacaïne-fentanyl a été associée à une amélioration de ľefficacité ďune thérapie médicale concourante pour bronchospasme. Avant de débuter le blocage péridural, on a employé de ľatropine par inhalation dans une tentative de réduire le tonus parasympathique des muscles lisses bronchiques. Une amélioration clinique soutenue ne s’est produite qu’après la sortie du foetus et du placenta.

Cardiac arrest upon induction of general anesthesia: transesophageal echocardiography-assisted diagnosis of impending paradoxical embolus.

CARDIAC arrest occurring upon the induction of general anesthesia in an otherwise healthy patient is distinctly rare. It is even more unusual to discover its etiology to be an impending paradoxical embolus (IPE). We present a case in which the timely use of transesophageal echocardiography (TEE), implemented during the course of cardiopulmonary resuscitation, revealed a large transatrial thromboembolus which had been trapped in transit through a patent foramen ovale.

Maternal Cortical Vein Thrombosis and the Obstetric Anesthesiologist

Maternal cortical vein thrombosis is a potentially fatal complication of pregnancy and the puerperium. Patients may present with focal neurologic deficits, seizures, or symptoms indicating increased intracranial pressure. Associated conditions include maternal dehydration and preeclampsia or frank eclampsia. Parturients may require anesthesia for various types of delivery. Safe administration of appropriate anesthesia must take into account the possible presence of a coagulopathy or reduced intracranial compliance. Case presentations, a literature review, possible pathogenetic mechanisms, and specific anesthetic considerations are discussed to enable the obstetric anesthesiologist to develop a rational plan of management.