Anesthetic management of a parturient with Eisenmenger’s syndrome: A case report

Eisenmenger’s syndrome results from certain uncorrected congenital abnormalities of the heart facilitating left to right shunt and chronic volume overload of the pulmonary vasculature, leading to irreversible changes in the pulmonary vasculature. Pregnancy in the patients of this syndrome is associated with a high risk of cardiovascular decompensation, thromboembolic complications, and sudden cardiac death. We present the case of a 25-year-old pregnant woman with Eisenmenger’s syndrome who delivered through the vaginal route at 37 weeks of gestation, under labor epidural anesthesia. A healthy male baby was delivered within 40 min of drug deposition in the epidural space. The postpartum period was essentially uneventful with successful maternal and neonatal outcomes.

Serum Magnesium Level as a Biomarker to Predict the Risk of Labor Epidural Anesthesia Associated Fever

Background: Labor epidural anesthesia-associated fever（LEAF) is the biggest problem for labor epidural anesthesia. This study aimed to evaluate the clinical value of serum magnesium levels to predict the LEAF.Methods: Finally, overall 528 singleton term-pregnant women who underwent labor epidural anesthesia in Fujian Provincial Maternity and Children's Health Hospital, affiliated hospital of Fujian Medical University from January 2019 to June 2019, were analyzed retrospectively. Using venous blood samples, the serum magnesium level was detected. The relationship between the serum magnesium level and LEAF was interpreted, and the optimal cut-off values of the serum magnesium level to predict LEAF were calculated. Results: Overall, 65（12.30%）participants had LEAF. And a higher rate of the bulging membrane, gestational hypertension, NICU admission, and the different mode of delivery was significantly associated with LEAF. Also, the serum magnesium level demonstrated higher significantly in LEAF presence than absence (p<0.05). What is more, it indicated that the area under the receiver operating characteristic curve (AUC) for the serum magnesium level was 0.825, and an optimal cut-off of the serum magnesium level was 0.855 mg/dl. Furthermore, it demonstrated that the serum magnesium level had the highest OR (OR= 7.49; 95% CI (4.58-14.35) ). The bulging membrane is an independent risk factor LEAF presence (OR = 1.55; 95% CI (1.01-2.43 ).Conclusions: Serum magnesium may reduce the incidence of LEAF. Serum magnesium can provide a suitable biomarker to predict LEAF and offer a useful target for LEAF treatment.

Can I have epidural analgesia if I have tinea versicolor?

Labor and delivery, while perceived as gratifying and joyful, are nonetheless among the most painful events women can experience in life. Treating pain is nowadays one of the essential elements in assisting women during labor. Epidural analgesia is the best option to ensure the optimal control of pain for the mother without compromising the wellbeing of the fetus. The main contraindications to neuraxial analgesia techniques include patient refusal, known bleeding diathesis or abnormal coagulation tests, elevated intracranial pressure (particularly in the presence of an intracranial space occupying lesion), severe aortic or mitralic valve stenosis and infections at the puncture site [1]. There are many pathogens responsible for cutaneous infections at the dorsal-lumbar level, yeasts of the Malassetia genus being the most commonly implicated. Malassetia Globulosa is the predominant species in the Tinea Versicolor infection [2,3]. Also implicated are M. Sympodialis, M. Furfur and others as well [4]. These fungi are normal components of the cutaneous flora but the transformation from yeasts to micelia can lead to the pathology. The cause for this occurrence is still unknown, yet there are a few contributing factors leading to this infection that affects mostly adolescents and young adults; these are genetic predisposition [5], heat and humidity, immunosuppression, contraceptives, pregnancy and malnutrition. It manifests with characteristic hypo- or hyper-pigmented spots alongside the trunk, the neck, and the face. The majority of the times infection is entirely superficial but cases of meningitis and Central Nervous System (CNS) infections from hematogenous spread have been reported [6,7]. The literature supports with data that adequate antiseptic preparation of the skin effectively prevents meningitis occurrence after epidural puncture [8]; other cases are reported where a small incision of the skin allows for a safer passage of the needle directly in the subcutis without going thnrough the corneal layer.

Factors associated with demand for epidural analgesia among women in labor at a tertiary hospital in Nnewi, South-East, NigeriaFactors associated with demand for epidural analgesia among women in labor at a tertiary hospital in Nnewi, South-East, Nigeria

Background: Epidural labor analgesia has become prevalent in high income countries, but its use in low and middle income countries such as Nigeria is poorly studied. Objectives: To determine the rate of demand, indications, post-dural puncture headache rate and factors affecting demand for epidural analgesia among women in labor. Method: This was a across sectional analytical study of women in labor who were managed at Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria from 1st January 2017 to 31st December 2017. Data was obtained from women’s case files from Medical record department, labor ward, and Anesthesiology departmental records. Information obtained included total number of deliveries, mode of delivery, those that received epidural: date and time of placement, indication and number of side effects. Univariate analysis models were applied to evaluate the association between patient demographic, socioeconomic factors, clinical and demand for labor epidural analgesia. A p-value of <0.05 was taken as significant. Results: Thirty-six women out of 1,373 women received epidural labor analgesia, giving the epidural labor analgesic rate of 2.6%. The most common indication for epidural labor analgesia was maternal voluntary request which accounted for 24 (66.7%) of the population receiving analgesia. One (2.8%) parturient developed post-dural puncture headache which resolved spontaneously within 24 hours. Parturient who utilized labor epidurals were significantly older than 30 years of age (OR 3.16; 95% CI 1.51-6.62; p=0.002), Multi-parous (OR 26.65; 95% CI 3.64-100.00; p=0.001), and with higher income (OR 9.02; 95% CI 4.38-18.57; p=<0.001), but not with higher level of education (OR 0.56; 95% CI 0.27-1.16; p=0.114). Conclusion: The demand for labor epidural in the study center was low with a demand rate of 2.6% and post-dural puncture headache rate of 2.8%. The significant factors related to a parturient’s request for epidural analgesia during labor included age greater than 30 years, multiparity and higher income. There is a need for an enhanced awareness programs on obstetrics epidural analgesia.