Orthotopic liver transplantation (OLT) has become a relatively safe procedure over the last decades, with reported 5-year survival rate of over 80%.    Increasing numbers of patients will be transplated at a younger age and they will seek obstetric anaesthesia services, as their fertility is restored after succesful transplantation. In 1978, the first succesful pregnancy was reported. Continue reading
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis characterized by progressive ossification of the spinal column with resultant stiffness. Patients, with AS, have a suppressed immune function due to proinflammatory cytokines and chemokines which are responsible for the inflammation of the joint. Continue reading
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
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
Behçet’s Disease is a chronic autoimmune disorder manifesting mainly with mucocutaneous ulcers (mostly in the oral cavity and the genitalia), ophthalmic lesions and systemic vasculitis. Neuro-Behçet is a severe though rare form of the disease. Behçet’s Disease effect on pregnancy is controversial with higher rates of miscarriage, but with symptoms remission during peripartum period. Mouth scarring from ulcers can complicate general anesthesia rendering intubation impossible and neuro-Behçet’s CNS complications can avert general techniques. Here, we present the case of a C-section in a parturient with this uncommon disease and the anesthetic considerations. Literature review is also discussed. Continue reading
Turner syndrome is a genetic disorder that was first described by Ullrich in 19301, followed by a report of a 7-women series with the phenotype of turner syndrome, “short-stature and gonadal dysgenesis”, by the American physician Henry Turner in 19382. The main phaenotypical characteristics of Turner syndrome are the short stature which is prevalent in approximately 9 out of 10 cases, the zygomandibular abnormalities, cardiovascular abnormalities, endocrine, and reproductive dysfunctions3. Continue reading
The number of pregnant women with morbid obesity (BMI 40–49.9 kg/m2) has significantly increased worldwide. Management of these patients presents a challenge for obstetric anesthesiologist. We report our management of cesarean delivery in a parturient with a BMI 47.3 kg/m2. We present this case to emphasize usefulness of Tuohy needle as an introducer for performing spinal anesthesia with a long 27G pencil point needle. Literature review is discussed. Continue reading

Intrathecal drug administration extends beyond the purposes of anaesthesia, to therapeutic applications. Here, we describe the case of a patient with severe Systemic Lupus Erythematosus having affected multiple organs and had a meningococcal infection. She was treated with intrathecal antibiotic therapy resulting in a successful outcome.

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