Term 3 Week 6 (w/c 4/6/12)
Good Morning. Welcome to this weeks Gasclass. Sorry for not posting yesterday but it’s another Bank (Public) Holiday here in the UK in celebration of the Queen’s Diamond Jubilee.
This week we are down in Obstetrics. You have been asked by the Obstetric Registrar to see a 28 year old lady who is 34/40 in her first pregnancy
What thoughts are going through your mind as you go to see her? More information later once we have had some responses.
Thank you for your comments so far.
You have been asked to see the lady as she has just moved into the area. In early childhood she suffered a traumatic C-spine injury resulting in tetraparesis. A caesarian section is planned for 38 weeks. She is 1.65m tall and weighs 85kg.
What would you like to know and what would be your anaesthetic plan?
Thanks for the further comments
Thank you for the further comments
You see the patient. She had C-spine fixation at the time of her original injury. Functionally she appears ok. She has diaphragmatic breathing and has not had any formal respiratory function tests. You discover that she has suffers with “abnormal” sensations below the level of the injury. She also suffers with lower body spasms and has an intrathecal baclofen pump. She has an awareness of getting hypertensive and sweaty in response to some somatic stimuli.
What are your thoughts now? How does this change your plan?
You have agreed to speak with your obstetric colleagues and she has been listed for LSCS as she is a breech presentation primip. You have informed the lady that you will discuss with colleagues as to an anaesthetic plan.
The lady presents at 0130am – 34/40 in labour. Still breech presentation
What are you going to do?
A case discussion will take place in our department today and we will feed back.
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