Regional Anaesthesia in Pre-eclampsia

Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review

Neuraxial anesthesia can be complicated by spinal or epidural hematoma and may result in permanent neurologic injury. There is a paucity of literature characterizing this serious complication in patients with congenital and acquired hemorrhagic disorders or tendencies. The objective of this scoping review was to describe the hemostatic laboratory parameters where neuraxial anesthesia has been administered with and without spinal and epidural hematoma in patients with preexisting hemorrhagic disorders and tendencies, including immune thrombocytopenia, gestational thrombocytopenia, thrombocytopenia associated with hypertensive disorders of pregnancy, platelet function disorders, von Willebrand disease, coagulation factor deficiencies, and fibrinogen disorders. A systematic search of Ovid MEDLINE, CINAHL, Embase, Scopus, and Web of Science was performed. Two authors independently reviewed all titles, abstracts, and full texts to determine study eligibility and extract data. Qualitative synthesis of 91 studies revealed significant gaps in our understanding of the risk of spinal and epidural hematoma in patients with hemorrhagic disorders and tendencies, including few studies of males and in nonobstetric settings. Most reviewed articles were small, retrospective studies at high risk for potential bias. With such low-quality data, we were unable to provide any true estimates of the risk of spinal or epidural hematoma for these patients, nor could we attribute any specific hemostatic or laboratory values to increased risk of hematoma. There is a need both for larger and more rigorously designed and reported studies on this subject and for structured, comprehensive recommendations for safe administration and removal of neuraxial anesthesia in patients with hemorrhagic disorders and tendencies.

Comparing the Effect of Spinal and General Anaesthesia for Pre-Eclamptic Mothers Who Underwent Caesarean Delivery in A Tertiary, Addis Ababa, Ethiopia

Background

Opinions are controversial regarding the use of general and spinal anesthesia in pre-eclamptic mothers undergoing Caesarean section. Some studies recommended avoiding spinal anesthesia in pre-eclamptic patients because of concern for sudden severe hypotension, while other studies support the use of spinal anesthesia as first choice reasoning less post-operative morbidity and mortality. This study aims to compare maternal outcome among pre-eclamptic women undergone caesarian delivery under general and spinal anesthesia.

Methods and Patients

A retrospective comparative cross-sectional study was conducted to compare maternal outcome. All pre-eclamptic mothers who underwent Caesarian section in Black Lion Specialized Hospital from October 2014 to October 2016 were included in the study. Data entry and analysis were conducted using SPSS version 20. Student's T-test was used to compare the outcome in both groups and p value < 0.05 was set as cut off point for statistical significance.

Results

A total of 170 client documents were reviewed. The mean age of the study subjects was 28.18 ± 4.66 years, with median age 28 years (IQR: 25–30). Our study shows that both general and spinal anesthesia have no difference in terms of maternal survival status, days of hospital stay, post-operative admission to ICU, and post-operative complications. However, this study found a statistically significant higher post-operative blood pressure and pulse rate among general anesthesia groups compared with spinal anesthesia group.

Conclusion

Spinal anesthesia is safer than general anesthesia in terms of stable vital signs among pre-eclamptic women undergoing Cesarean section.

Intracranial foreign body (bullet) during pregnancy

Intracranial foreign bodies during pregnancy is a very rare condition, however its maternal and fetal outcomes are very crucial with regard to morbidity and mortality. Furthermore wounding by firearms is still a public health problem particularly in our country. Intracranial foreign bodies during pregnancy is high risk pregnancy and must be managed with care and multidisciplinary approach. During this course and labour avoiding the increase in intracranial pressure is the most important key point. In this case report we present the follow-up and outcome of a patient with bullet in brain after intracranial injury caused by firearm.