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1. Severe fetal bradycardia in a pregnant surgical patient despite normal oxygénation and blood pressure

Author

E.L. Stearns, Ron Segstro, Bill Y. Ong, Don Paetkau, Cynthia M. Baron, and Ken Baron

Subjects
Bradycardia, medicine.medical_specialty, business.industry, medicine.medical_treatment, Tracheal intubation, Remifentanil, Fetal Bradycardia, General Medicine, Surgery, Anesthesiology and Pain Medicine, Blood pressure, Anesthesiology, Anesthesia, Heart rate, medicine, Apgar score, medicine.symptom, business, medicine.drug
Abstract

To report and discuss a case of fetal bradycardia in a parturient under anesthesia for cholecystectomy despite normal maternal oxygenation and arterial blood pressure. A 27-yr-old woman (gravida 2 para 1), with a fetus of 34 weeks gestation, received general anesthesia for cholecystectomy. After anesthesia induction and tracheal intubation, anesthesia was maintained with oxygen, sevoflurane andiv remifentanil infusion. While preparing for surgery, the fetal heart rate decreased within about half a minute to 70 beats · min−1 and remained at that level. The maternal blood pressure, heart rate and oxygen saturation were normal. An emergency Cesarean delivery was performed. The infant had Apgar scores of 1 at one minute, 5 at five minutes, 7 at ten minutes and required resuscitation after birth. Ideally, women having non-obstetric surgery during the third trimester of pregnancy will have intraoperative fetal heart rate monitoring.

Published
2003
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2. Abstracts

Author

C. A. Botero, C. E. Smith, C. Holbrook, A. C. Pinchak, David Johnson, Dorothy Thomson, Taras Mycyk, M. Burbridge, Irvin Mayers, nR. W. M. Wahba, F. Belque, S. J. Kleiman, Steven Parker, Peter Cox, Helen Holtby, Lawrence Roy, Marc A. St-Amand, John M. Murkin, Donna Baird, Donal B. Downey, Alan H. Menkis, Fan Yang, Éric Troncy, Martin Francœur, Marc Charbonneau, Patrick Vinay, Gilbert Blaise, William M. Splinter, David J. Roberts, Elliot J. Rhine, Helen B. MacNeill, Craig W. Reid, William PS McKay, Miklavs Erjavec, Benjamin W. S. McKay, Peter H. Gregson, Travis Blanchet, Guy Kember, Josée Lavoie, Daniel Vischoff, Louise Cyrenne, Edith Villeneuve, Pierre Williot, A. K. Raghupathy, R. Haug, B. Punjabi, F. Ditzig, Howard Melnik, Michael J. Tessler, L. Jill Krasner, David M. Corda, Kal Solanki, A. Joseph Layon, T. James Gallagher, Daniel P. Stoltzfus, Shannon L. Rabuka, Carol A. Moote, Robert J. B. Chen, Doreen A. Yee, Ellen Harrington, Beverley A. Orser, D. Mitch Giffin, Kenneth W. Gow, P. Terry Phang, Keith R. Walley, C. Brian Warriner, Matthew H. Cohen, Andrew J. Klahsen, Deirdre O’Reilly, John McBride, Margaret Ballantyne, Blair D. Goranson, Scott Lang, William N. Dust, Jeff McKerrell, Guy Martin, René Martin, Daniel Martin, Philippe Valet, Jean-Pierre Tétrault, Caroline Dagenais, Martine Pirlet, Dominique Dansereau, Pedro D’Orléans-Justes, Agnès Jankowska, Yves Veillette, Angela L. Mathieson, Howard Intrater, Lionel Cruickshank, P. C. Duke, B. Y. Ong, Vincent Woo, Donna Schimnowski, Sharon Trosky, Linda Dalton, Ibrahim Zabani, Colin R. Chilvers, Himat Vaghadia, Pamela M. Merrick, Ibrahim Kashkari, Hossam Al-Oufi, D. Jolly, B. T. Finucane, Wolfgang Weyland, Ulrich Fritz, Heike Landmann, Ingrid Schumacher, Michael English, Dietrich Kettler, Catherine M. Duffy, Pirjo H. Manninen, Frances Chung, Shanthini Sundar, Emilio B. Lobato, Orlando Florete, Glenn B. Paige, Thierry Daloze, Daniel A. Chartrand, Denis St-Laurent, Gordon S. Fox, Murray L. Rice, D. John Doyle, George A. Volgyesi, Joseph A. Fisher, Arthur Slutsky, Igor Salazkin, Karen A. Brown, Pradeep Kulkarni, Bibiana Cujec, Randy McCuaig, Tom Hurst, David Antecol, François Bellemare, Jacques Couture, Manon Marchand, Peter McNeil, Orlando Hung, Lily M. Ho-Tai, J. Hugh Devitt, Alva G. Noel, Michael P. O’Donnell, Robert J. Greenhow, Frank W. Cervenko, Brian Milne, Mark D. Peterson, Ian R. Thomson, Robert J. Hudson, Morley Rosenbloom, Michael Moon, Jitender Sareen, H. Locke Bingham, Steven B. Backman, Reuben D. Stein, C. Polosa, Michael Tessler, Salvatore M. Spadafora, John G. Fuller, Lisa Kim, Keyvan Karkouti, D. Keith Rose, Lorraine E. Ferris, DK Rose, MM Cohen, F. E. Ralley, B. DeVarennes, M. Robitaille, Norman Searle, Raymond Martineau, Peter Conzen, A. Al-Hasani, Tom Ebert, Michael Muzi, Jean-François Hardy, Sylvain Bélisle, André Couturier, Danielle Robitaille, Micheline Roy, Lyne Gagnon, Elisabeth J. Avraamides, P. J. Dryden, J. P. O’Connor, W. R. E. Jamieson, I. Reid, D. Ansley, H. Sadeghi, L. H. Burr, A. I. Munro, P. M. Merrick, Mark Benaroia, Andrew Baker, C. David Mazer, Lee Errett, Luc Frenette, Jerry Cox, Donna Kerns, Steve Pearce, David Mark, Paul McDonagh, Lulz DeLlma, Howard Nathan, Jean-Yves Dupuls, J.Earl Wynands, G. C. Moudgil, J. G. Johnson, G. M. Moudgil, Richard I. Hall, Connie MacLaren, M. J. Ali, M. Ballantyne, D. Norris, Stephen D. Beed, Eugene A. Menard, Leon P. Noel, Gary G. Bonn, William Clarke, H. Marion Gould, Leslie E. Hall, Philippe Bernard, Juan Bass, Ramona A. Kearney, Cheryl A. Mack, Lucy M. Entwistle, Joan C. Bevan, Andrew J. Macnab, Guy Veall, Colin Marsland, Craig R. Ries, Shahnaz K. Hamid, Ian R. Selby, Nancy Sikich, Elizabeth Hsu, Patricia McCarthy, Ching-Yue Yang, Wun-Chin Wu, Jiunn-Jye Huang, Shyu-Yin Chen, Hsiang-Ning Luk, Chok-Yung Chai, Gina K. Lafreniere, Donald G. Brunet, Joel L. Parlow, Hossam El-Beheiry, Aviv Ouanounou, Mary Morris, Peter Carlen, Pamela J. Morgan, Roger Chapados, Marlene Gauthier, John W. D. Knox, Jacques LeLorier, Roddy Lin, Keith Rose, Bernadette Garvey, Robert McBrobm, L. C. McAdam, J. F. MacDonald, B. A. Orser, Georgios koutsoukos, Susan Belo, Christopher A. Chin, Brendan O’Hare, Jerrold Lerman, Junko Endo, Arthur E. Schwartz, Oktavijan Minanov, J. Gilbert Stone, David C. Adams, Aqeel A. Sandhu, Mark E. Pearson, William L. Young, Robert E. Michler, Ernest Cutz, Matt M. Kurrek, Marsha M. Cohen, Kevin Fish, Pamela Fish, Patricia Murphy, Donald Fung, Alva Noel, John-Paul Szalai, Ari Robicsek, Joshua Rucker, Joshua Kruger, Mark Slutsky, Leeor Sommer, Jeff Silverman, Jodi Dickstein, Viren Naik, Douglas J. Hemphill, Regina Kurian, Khursheed N. Jeejeebhoy, Osama A. Alahdal, N. H. Badner, W. E. Komar, R. Bhandari, R. Craen, D. Cuillerier, W. B. Dobkowski, M. H. Smith, A. N. Vannelli, R. B. Bourne, C. H. Rorabeck, J. A. Doyle, Antoinette Corvo, Richard M. Wahba, Nathalie Scheffer, John Y. C. Tsang, Brad A. Brush, N. Q. N’Guyen, C. Orain, S. Tougui, G. Lavenac, D. Milon, Ewan D. Ritchie, Doris Tong, Andrew Norris, Anthony Miniaci, Santhira D. Vairavanathan, Timothy FitzPatrick, Mark Stafford-Smith, Ken Kardash, Toula Trihas, Simcha J. Kleiman, Michel Rossignol, Dominique Bérard, Brent Martel, J. P. Tétrault, Peter G. Lunt, Dennis W. Coombs, Stephen Halpern, Elizabeth A. Peter, Patricia Janssen, Jill Mahy, M. Joanne Douglas, Caroline S. Grange, Timothy J. Adams, Louis Wadsworth, Holly Muir, Romesh Shukla, Desmond Writer, Richard McLaren, Robert Liston, Don Paetkau, Bill Y. Ong, Ron Segstro, Judy Littleford, Cristina Hurtado, Ananthan Krishnathas, Marcelo Lannes, Joanne Fortier, Jun Su, Rubini Jeganathan, and Suzanne Vaillancourt

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
1996
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3. Severe fetal bradycardia in a pregnant surgical patient despite normal oxygenation and blood pressure

Author

Bill Y, Ong, Ken, Baron, Eric L, Stearns, Cynthia, Baron, Don, Paetkau, and Ron, Segstro

Subjects
Adult, Methyl Ethers, Cesarean Section, Infant, Newborn, Blood Pressure, Anesthesia, General, Heart Rate, Fetal, Severity of Illness Index, Fetal Distress, Oxygen, Remifentanil, Sevoflurane, Piperidines, Heart Rate, Pregnancy, Anesthetics, Inhalation, Apgar Score, Bradycardia, Humans, Cholecystectomy, Female, Fetal Monitoring, Anesthetics, Intravenous
Abstract

To report and discuss a case of fetal bradycardia in a parturient under anesthesia for cholecystectomy despite normal maternal oxygenation and arterial blood pressure.A 27-yr-old woman (gravida 2 para 1), with a fetus of 34 weeks gestation, received general anesthesia for cholecystectomy. After anesthesia induction and tracheal intubation, anesthesia was maintained with oxygen, sevoflurane and iv remifentanil infusion. While preparing for surgery, the fetal heart rate decreased within about half a minute to 70 beats x min(-1) and remained at that level. The maternal blood pressure, heart rate and oxygen saturation were normal. An emergency Cesarean delivery was performed. The infant had Apgar scores of 1 at one minute, 5 at five minutes, 7 at ten minutes and required resuscitation after birth.Ideally, women having non-obstetric surgery during the third trimester of pregnancy will have intraoperative fetal heart rate monitoring.

Published
2003

4. Spinal anaesthesia for Caesarean section in a patient with a cervical arteriovenous malformation

Author

Ron Segstro, I. Sutton, D. Paetkau, Judith Littleford, and Bill Y. Ong

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, Anesthesia, Spinal, Arteriovenous Malformations, Pregnancy, Anesthesiology, medicine, Anesthesia, Obstetrical, Humans, Caesarean section, Vascular disease, business.industry, Cesarean Section, Spinal anesthesia, Arteriovenous malformation, General Medicine, medicine.disease, Spinal cord, Surgery, Pregnancy Complications, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Spinal Cord, Regional anesthesia, Anesthesia, Female, business
Abstract

Arteriovenous malformations (AVM) of the spinal cord are rare. We report the successful management of a patient with a cervical spinal cord AVM undergoing Caesarean section delivery, using a spinal anaesthetic.Based on previous radiological investigations, the patient was known to have an AVM at the third cervical level of her spinal cord. After application of monitors and intravenous administration of 1 L normal saline, a 25 g Whitacre needle was inserted into the subarachnoid space at the L3-4 interspace. Spinal anaesthesia was established with a solution consisting of hyperbaric spinal bupivacaine 12 mg, fentanyl 12.5 micrograms and epidural morphine 0.25 mg. There was no neurological deficit during hospital stay or after discharge.The safe outcome of spinal anaesthesia for our patient is encouraging. The presence of spinal cord AVM at the cervical region is not an absolute contraindication to spinal anaesthesia.

Published
1996

5. Respiratory depression associated with meperidine spinal anaesthesia

Author

Ron Segstro and Bill Y. Ong

Subjects
Adult, medicine.medical_specialty, Respiratory rate, Meperidine, Sterilization, Tubal, Hernia, Inguinal, Anesthesia, Spinal, Naloxone, Medicine, Humans, Respiratory system, Oxygen saturation, Injections, Spinal, Aged, Aged, 80 and over, Tubal ligation, business.industry, Respiration, General Medicine, Oxygenation, Surgery, Pethidine, Oxygen, Anesthesiology and Pain Medicine, Anesthesia, Midazolam, Female, business, Respiratory Insufficiency, medicine.drug
Abstract

Intrathecal meperidine administration can provide surgical anaesthesia and postoperative analgesia for about two to six hours. We have observed two cases of respiratory depression associated with meperidine spinal anaesthesia. An 81-yr-old woman received 50 mg intrathecal meperidine for inguinal hernia repair. Supplemental oxygen was administered at 3 L · min−1 by nasal prongs. About 40 min later, the patient’s oxygen saturation decreased from 97% to 87% and she was asked to take big breaths. She responded immediately and oxygen saturation returned to 97%. Two more similar episodes followed in the next five minutes. Naloxone 0.1 mg iv was administered and the oxygen saturation remained at 96–97% until completion of surgery about 15 min later. She had an uneventful recovery. A 24-yr-old healthy woman presented for tubal ligation eight hours after vaginal delivery of an infant. The surgical procedure was performed under spinal anaesthesia produced by 50 mg meperidine. During surgery, midazolam 2 mg iv was given for anxiolysis. About five minutes after admission to the postanaesthesia care unit, the patient’s respiratory rate decreased to ten breaths per minute and oxygen saturation decreased to 89%. Supplemental oxygen at 3 L · min−1 was administered by nasal prongs. The patient was encouraged to take big breaths and the arterial oxygen saturation rapidly increased to 98–99%. Forty minutes later, nasal oxygen was discontinued. The patient maintained her oxygen saturation while breathing room air. She was then discharged to the ward and had an uneventful recovery course. We recommend that a patient’s respiratory variables and oxygenation be closely monitored for at least one hour after intrathecal meperidine administration.

Published
1994

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