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
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
The aim of this study was to compare the level of sensory block in parturients with different body height, after spinal anesthesia with local anesthetic of fixed volume and consistence. This retrospective study was conducted on 107 women, which underwent caesarean section under spinal anesthesia. It was hypothesized that maternal height was not associated with level of sensory block. Parturients were divided into two groups, based on their body height. Group A (n=65) included those with height ≤165 cm and group B (n=42) those with height of ≥166 cm. Subarachnoid space was reached with a 25G needle through the L3-L4 spinal space. Then, ropivacaine 20mg and 10mcg fentanyl (in solution of 2.8 ml) was given...
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