Spinal anaesthesia for caesarean delivery in a parturient with babesiosis and Lyme disease

We present a case of a parturient with babesiosis and Lyme disease who was scheduled for elective caesarean section. The caesarean section was performed under spinal anaesthesia, and the patient had a coronary artery dissection 4 days postoperatively. Neuraxial anaesthesia and possible mechanisms for the coronary artery dissection in a patient with babesiosis and Lyme disease are discussed.     

Anaesthetic management of caesarean delivery in a parturient with malaria

Malaria is a life-threatening illness with significant maternal and infant morbidity and mortality worldwide. Due to the rarity of its diagnosis in the UK population, there is little information about the number of pregnant women affected by malaria. This report describes a primiparous woman requiring a category-1 emergency caesarean section for severe sepsis, in whom the cause of sepsis was found to be Plasmodium vivax malaria. A brief overview of malaria in pregnancy as relevant to this case and its outcome is presented. The report highlights the need for vigilance of all healthcare providers to allow timely recognition and management of rare but treatable disorders.     

General anaesthesia for caesarean section in a parturient with Noonan's syndrome

We describe the anaesthetic management of a parturient with Noonan's syndrome. Her problems included severe cardiac disease, facial abnormalities and extreme phobia to needles. After intrauterine death at 30 weeks gestation, induction of labour was attempted and extradural analgesia initiated using low-dose bupivacaine. She failed to progress and underwent Caesarean section under general anaesthesia using awake oral fibreoptic intubation.      

Regional anaesthesia for multiple caesarean sections in a parturient with osteogenesis imperfecta

We describe a 27-year-old woman with osteogenesis imperfecta who, over a period of 9 years, underwent five caesarean sections under regional anaesthesia without major complication. The first three operations were conducted under epidural and the last two under spinal anaesthesia. To our knowledge, this is the first reported case of spinal anaesthesia for caesarean section in a parturient with osteogenesis imperfecta.     

Autoimmune progesterone dermatitis in a parturient for emergency caesarean section

A parturient with a 14-year history of autoimmune progesterone dermatitis presented in labour at 36 weeks' gestation. She had suffered recurrent episodes of angioedema over a long period and had been scheduled for elective caesarean hysterectomy and bilateral oophorectomy at 37 weeks' gestation. In most cases surgical oophorectomy provides prolonged relief from the recurrent angioedema and dermatological manifestations that are typical of autoimmune progesterone dermatitis. Spinal anaesthesia was chosen in order to avoid airway manipulation, a factor frequently implicated in the development of angioedema. Delivery was uneventful and the obstetricians proceeded to hysterectomy and oophorectomy. Forty minutes after delivery the patient experienced an attack of angioedema, she was markedly hypotensive and was given fluids, ephedrine and phenylephrine with good effect. As she remained normotensive, she was given intramuscular rather than intravenous epinephrine to provide a slower release. She recovered well and stabilised without the need for intubation or ventilation. This case reinforces the rationale for regional anaesthesia in these patients and demonstrates how intramuscular epinephrine contributed towards a positive outcome.     

Spinal anaesthesia for caesarean section in a patient with Cockayne syndrome

Cockayne syndrome is a rare inherited disorder with photosensitivity, dysmorphism, short stature and neurological deficits. Sufferers with this condition rarely survive into reproductive life. We report the successful delivery of a woman in her second pregnancy with Cockayne syndrome, her first pregnancy having resulted premature labour, caesarean section under spinal anaesthesia with considerable hypotension, and neonatal death. On this occasion she was hospitalised at 19 weeks' gestation and delivered by elective caesarean section at 34 weeks. She had a Mallampatti score of 3, so spinal anaesthesia using 1.8 mL of hyperbaric bupivacaine was given with good effect and mother and baby did well. The aetiology and clinical symptoms of this rare congenital syndrome, together with the anaesthetic implications and management, are described and discussed.     

Spinal anaesthesia for caesarean section in a patient with cervical cord compression

The anaesthetic management a of 42-year-old woman with significant symptomatic cervical cord compression, who presented for emergency caesarean section, is presented. She declined to have general anaesthesia in any circumstance and had the surgery conducted under spinal anaesthesia, without developing any postoperative neurological deterioration. The implications of various anaesthetic options are discussed along with the role of patient's wishes in anaesthetic decision-making.     

Anaesthesia for caesarean delivery in a parturient following a recent cerebrovascular event

Ischaemic cerebrovascular events in pregnancy are uncommon. The anaesthetic management of a pregnant patient within six weeks of an ischaemic cerebrovascular event has not previously been reported. Issues raised include consent and minimising further neurological insult. Changes in regional blood flow, cerebral metabolic rate and integrity of the blood brain barrier must be considered although evidence to support regional in preference to general anaesthesia is lacking. We report the case of a woman with known systemic lupus erythematosis and antiphospholipid syndrome who developed idiopathic thrombocytopenic purpura in pregnancy and suffered a thrombotic cerebral vascular accident at 32 weeks of gestation. Ten days later she required urgent caesarean delivery, which was performed under general anaesthesia. There was no deterioration in neurological function following surgery and eight days postoperatively she was transferred to a neuro-rehabilitation centre for further care. The idiopathic thrombocytopenic purpura did not respond to medical therapy following delivery and a second anaesthetic was required for splenectomy four weeks later.     

Anaesthetic management of emergency caesarean section in a parturient with systemic mastocytosis

Mastocytosis is a rare disorder caused by the proliferation and accumulation of mast cells in various organs. It has a broad variety of clinical manifestations, including cardiovascular collapse. Diverse stimuli trigger the release of vasoactive substances and parturients with systemic mastocytosis are at high risk for precipitating mast cell degranulation. As a result, women with systemic mastocytosis should have an anaesthetic plan for labour and delivery. Anxiety, stress, sleep deprivation, pain and numerous pharmacological agents are all triggers for mast cell degranulation. For pain relief in labour, epidural analgesia is recommended. Pharmacological agents with a high potential for triggering mast cell degranulation should be avoided. This is particularly important in the case of an emergency caesarean section. Resuscitation equipment must be available should life-threatening haemodynamic instability occur during surgery. We report the case of a pregnant woman with systemic mastocytosis who required emergency caesarean section.     

Spinal and epidural anaesthesia for caesarean section in patients with pre-eclampsia

Neuraxial regional anaesthesia is now widely used in obstetric anaesthesia. Specifically, the rate of spinal anaesthesia increased considerably and is favoured for scheduled caesarean section. Former concerns to use regional anaesthetic techniques in non scheduled cases, e.g. spinal anaesthesia for pre-eclampsia are not supported by recent study data. Spinal and epidural anaesthesia are both safe in patients presenting with pre-eclampsia, if contraindications for neuraxial anaesthesia are taken into account.