G. Dahlgren

Treatment of idiopathic intracranial hypotension: cervicothoracic and lumbar blood patch and peroral steroid treatment.

Methods.—Twelve consecutive patients with clinical symptoms and testing results compatible with a diagnosis of idiopathic intracranial hypotension (IIH), but no identifiable site of cerebrospinal fluid (CSF) leakage, were treated with a cervicothoracic or lumbar epidural “blood patch” (EBP) or orally administered steroids.

Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey

Background: A major risk with epidural analgesia is accidental dural puncture (ADP), which may result in post‐dural puncture headache (PDPH). This survey was conducted to explore the incidence of ADP, the policy for management of PDPH and the educational practices in epidural analgesia during labour in the Nordic countries.

Low dose intrathecal morphine effects on post-hysterectomy pain: a randomized placebo-controlled study

Spinal anesthesia with different doses of intrathecal morphine has been shown to relieve post‐operative pain. We studied in a prospective randomized, double‐blind fashion the effects of morphine 0, 100, 200, or 300 μg added to intrathecal bupivacaine on first post‐operative 24 h patient‐controlled analgesia morphine (PCA‐morphine) consumption after abdominal hysterectomy under general anesthesia.

The definition of hypotension affects its incidence

HYPOTENSION regularly accompanies spinal anesthesia during cesarean section. It is often associated with maternal discomfort and may, rarely, affect the mother or the fetus seriously. As there is no universally accepted definition of hypotension, it is not surprising that several different definitions are used in the literature. This obviously makes comparisons between studies more difficult. In this issue of the Acta Anaesthesiologica Scandinavica, Roth and colleagues present their work entitled ‘Definitions of hypotension after spinal anesthesia for cesarean section: literature search and application to parturients.’ In 63 studies between 1999 and 2009, 15 different definitions of hypotension were used. The two most common were a decrease in systolic arterial pressure to less than 80% from a baseline value (25% of studies) and either a reduction in systolic arterial pressure below 100 mmHg or a relative reduction below 80% (21% of studies). In the second part of the study, the authors applied the different definitions of hypotension from the literature study on 107 patients during cesarean section under spinal anesthesia at their own institution. The main finding was that the incidence of hypotension varied 10-fold depending on the definition. The definition of the baseline blood pressure was given in 53/63 studies, but it is not clear whether this included a standardization of the position of the patient. With the patient in the supine position, a left lateral tilt of the operating table of at least 151 is required to minimize the risk for hypotension. To avoid the problem with defining a supine position with a specific left lateral tilt, the full lateral position may be used during baseline blood pressure measurements. Also, the blood pressure will vary between the arms when the supine patient is rotated to the left. The dependent (left) arm has been recommended for blood pressure measurements in this situation. A different but important question is whether baseline measurements in the operating room immediately before a cesarean section reflects the true picture accurately. Personally, in the clinical situation with healthy parturients, we tend to use the average of several blood pressure measurements during late pregnancy as the baseline value. For a definition of hypotension to be useful, values below a cut-off blood pressure should ideally be of clinical significance for mother or fetus. This cut-off would, however, vary between healthy parturients with normal pregnancies and patients with coexisting disease or with a fetus in distress, making it difficult, if not impossible, to establish. Usually, this problem is handled through an active approach in prophylaxis and treatment, with the goal of maintaining the baseline blood pressure. With this approach, the establishment of a correct baseline blood pressure will be even more important. Another aspect of blood pressure measurement is the interval used for repeated measurements. Even this parameter may affect the reported frequency of hypotension. The short-lived hypotension after a bolus dose of intravenous (i.v.) oxytocin or the rapid changes in hemodynamics after an intrathecal injection of a local anesthetic may thus be missed or underestimated if blood pressure is measured with longer than 1-min intervals. The finding in the present study that the definition of hypotension affects its incidence was previously studied prospectively. In an RCT between crystalloid and colloid preload, hypotension was found to vary between 13% and 75% depending on the definition. The addition of maternal discomfort

Auditory function following post-dural puncture headache treated with epidural blood patch. A long-term follow-up

Epidural analgesia is commonly used for pain management during labor. Sometimes, accidental dural puncture (ADP) occurs causing severely debilitating headache, which may be associated with transient hearing loss. We investigated if auditory function may be impaired several years after ADP treated with epidural blood patch (EBP).