Anaesthetic Management of a Parturient with Severe Preeclampsia and a History of Liver Transplantation: A Case Report and Short Literature Review.

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 →

Category: 2023, 2023c, Review Articles, Case Reports
Keywords: Liver transplantation, obstetric anaesthesia, preeclampsia
Authors (a/b order): Antonogiannakis A., Skandalou V., Stamatakis E., Valsamidis D.

Challenges in anaesthetic management of ankylosing spondylitis for elective gynaecological oncologic procedures: A Case Report

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 →

Category: 2023, 2023b, Case Reports
Keywords: anesthesia, ankylosing spondylitis, gynaecological procedures
Authors (a/b order): Pavlidis M., Stamatakis E., Valsamidis D., Varvarousi G.

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.

Caesarean section in a parturient with Behçet’s Disease: Case report and literature review

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 →

Category: 2022, 2022a, Case Reports
Keywords: airway management, Behçet’s Disease, caesarean section, general anesthesia, Neuro-Behçet
Authors (a/b order): Stamatakis E., Tsianos V., Valsamidis D.

Anaesthetic management of a parturient with Turner syndrome and preeclampsia for cesarean section: A Case Report and Literature Review

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 →

Category: 2021, 2021c, Case Reports
Keywords: cesarean section, pre-eclampsia, premature, Turner syndrome, uterine atony
Authors (a/b order): Papadopoulou D., Pavlidis M., Stamatakis E., Valsamidis D.

A case of extremely increased maternal age cesarean section infected by Covid 19

The novel coronavirus disease 2019 (COVID-19) caused by severe respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global health emergency since its declaration as a pandemic by the World Health Organization. Advanced maternal age is considered a high-risk pregnancy and therefore may affect the severity of Covid-19¹. Data regarding the management and outcome of a cesarean section in an extremely increased aged woman with Covid-19 disease are limited to a few case reports. In this case report, we discuss the perioperative management of an in vitro fertilization (IVF) cesarean section in a 48-year-old woman with Covid-19 infection. Continue reading →

Category: 2021, 2021c, Case Reports
Keywords: caesarean, covid-19, increased maternal age
Authors (a/b order): Haidopoulos D., Lappas T., Loukeri A., Valsamidis D., Varvarousi G.

ANESTHETIC MANAGEMENT OF MORBIDLY OBESE PARTURIENT FOR CESAREAN SECTION: A CASE REPORT AND LITERATURE REVIEW.

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 →

Category: 2021, 2021a, Case Reports
Keywords: airway management, cesarean section, Morbid obesity, neuraxial anesthesia, post-dural puncture
Authors (a/b order): Hadzilia S., Pavlidis M., Stamatakis E., Tsimpinos E., Valsamidis D.

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 →

Category: 2020, 2020a, Case Reports
Keywords: AIFM1 mutation, caesarean section, combined spinal epidural, mitochondrial disease, mitochondrial encephalopathy
Authors (a/b order): Antsaklis P., Kalopita K., Saiti A., Valsamidis D.

Meningitis treatment through an epidural catheter Case Report

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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Category: 2014, 2014b, Case Reports
Keywords: epidural catheter, meningitis
Authors (a/b order): Aroni F., Loukeri A., Stamatakis E., Valsamidis D.