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Postdural puncture headache: an update on treatment in obstetric patients

Neuraxial analgesia and anaesthesia in an obstetric patient is associated with the risk of accidental dural puncture and subsequent development of a post dural puncture headache (PDPH). The management of accidental dural puncture requires consists of prevention of PDPH, patient’s information, early diagnosis, treatment, and monitoring until remission of PDPH. Continue reading →

Category: 2023, 2023a, Review Articles
Keywords: epidural blood patch, obstetric anesthesia, Post dural puncture headache
Authors (a/b order): Klimi P., Lappas T., Saiti A., Stamatakis E., Tzaneti A., Valsamidis D., Varvarousi G.

Μαιευτική Αιμορραγία και Διαταραχές Αιμόστασης: Περιεγχειρητική Διαχείριση Αιμοθεραπείας

Obstetric haemorrhage is the leading cause of mortality in parturients. In massive haemorrhage, fibrinogen is the first coagulation factor to decrease and a value < 2 gr/lt is a prognostic indicator of severe haemorrhage. A small decrease in fibrinogen leads to an increased effect on coagulability and continued haemorrhage. Coagulation disorders may be due to either consumption of coagulation factors or dilution. The type, severity and time of onset of the coagulation disorder depend on both the size and the cause of the haemorrhage. Early recognition of the cause of haemorrhage, low fibrinogen and its immediate correction are essential in the perioperative management of haemorrhage. Continue reading →

Category: 2022b, Review Articles
Keywords: fibrinogen, Obstetric haemorrhage, viscoelastic coagulation measurements
Authors (a/b order): Iliopoulou Ch., Klimi P., Papa M., Saiti A., Scandalou V., Stamatakis E., Valsamidis D., Varvarousi G.

PERIOPERATIVE MANAGEMENT OF MITOCHONDRIAL ENCEPHALOPATHY ASSOCIATED WITH A NOVEL AIFM1 MUTATION IN A HIGH-RISK PREGNANCY: A CASE REPORT

Mitochondrial diseases represent a wide range of disorders caused by impairment of mitochondrial metabolism and energy production. We report a case of an uneventful perioperative management of a pregnant patient with early childhood-onset mitochondrial encephalopathy, attributed to a novel AIFM1 (Apoptosis-Inducing Factor, Mitochondrion-associated 1) mutation. After a multidisciplinary team consultation, it was decided to be posted for elective caesarean delivery at 36⁺² weeks of gestation, under titrated combined spinal-epidural anaesthesia and multimodal analgesia. Unique anaesthetic challenges were to ensure normoglycaemia, normothermia and adequate hydration while avoiding perioperative stress and acidosis. Continue reading →