Spinal anaesthesia for Caesarean section

Lucy, Simon J.; Naugler, Mary Anne K.

doi:10.1007/bf03036986

Cited by 8 publications

(2 citation statements)

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“…,6 Our local experience is that, by using elastic stockings and aggressive fluid loading, the degree of hypotension and use of ephedrine does not differ between patients receiving subarachnoid or epidural anaesthesia for Caesarean delivery. 22 Amide local anaesthetics were originally proscribed in MH patients on theoretical grounds based on their in vitro ability to increase calcium efflux from sarcoplasmic reticulum.23 However, this class of drugs has been used extensively in MH patients without demonstrable adverse reactions. 24 As a result, the Malignant Hyperthermia Association of the United States (MHAUS) issued a policy statement in 1985 stating that amide local anaesthetics were considered safe in MH patients, z~ Based on this, and since bupivacaine gives a better quality spinal anaesthetic than an ester such as tetracaine, 26 we did not hesitate to use the amide agent.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia for Caesarean delivery of a malignant hyperthermia susceptible parturient

Lucy

1994

Can J Anaesth

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The anaesthetic management for Caesarean delivery of a parturient with a strong family history of malignant hyperthermia (MH) is presented. Before surgery an anaesthetic machine that was in regular use was prepared by replacing all rubber or disposable components and flushing with 02 at 10 L" rain -t for one hourAccepted for publication 5th August, 1994. Since malignant hyperthermia (MH) was first described there have been a number of case reports of MH reactions in obstetrical patients ,-3 and descriptions of management plans for the susceptible parturient. 4-7 Not surprisingly, as our understanding of this condition has evolved, so too has our approach to it. The following case report details our recent experience with a pregnant patient at risk for MH and describes how our management has changed in the light of new information about the condition and its triggering agents. Case reportThe patient was a healthy 29-yr-old G2PI scheduled for elective repeat Caesarean delivery. Four years previously she had had an operative delivery, because of failure to progress, under an epidural anaesthetic using bupivacaine, carbonated lidocaine, and fentanyl. Subsequent to this her niece had an MH reaction during general anaesthesia. Two of her sisters proved to be muscle biopsy positive, but the patient herself had not been tested. She had also had a scar revision under lidocaine infdtration, but had never had a general anaesthetic. She reported a codeine allergy and an aversion to caffeine.The patient was first seen by a member of the Department of Anaesthesia through the Same Day Admission for Caesarean Clinic one week before her scheduled delivery. The reasons for considering her MH susceptible, and how this would affect management, including the choice of anaesthetic and monitoring, were discussed. She was in favour of regional anaesthesia and agreed to a spinal technique.The patient was admitted to hospital on the morning of surgery. Preoperative preparation consisted of sodium citrate 30 ml po and being fitted with anti-thromboembolic stockings.One hour before surgery, the operating room was prepared by removing all recognized MH triggering agents from the room, including succinylcholine and the vaporizers from an Ohmeda Modulus II anaesthetic machine.

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Section: Discussionmentioning

confidence: 99%

Anaesthesia for Caesarean delivery of a malignant hyperthermia susceptible parturient

Lucy

1994

Can J Anaesth

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“…The main advantage being its simplicity, ease of technique and reliability [3,4] . Till recently bupivacaine was the only drug used after discontinuation of intrathecal lidocaine use [5] .…”

Section: Imentioning

confidence: 99%