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    Anaesthesia for caesarean delivery in a pregnant with acute type B aortic dissection
    (2013) Kayhan G.E.; Gülhaş N.; Şahin T.; Özgül Ü.; Şanli M.; Durmuş M.; Ersoy M.Ö.
    About 50% of aortic dissections in women younger than 40 years occur during pregnancy; mostly in the 3rd trimester and postpartum period. Aortic dissection in pregnancy creates a serious mortality risk for both mother and the foetus. The ultimate goal is to ensure the safety of both the mother and the foetus. In such cases, the best method of anaesthesia for caesarean delivery is still controversial. The first aim of anaesthetic management is to reduce the effect of cardiovascular instability on the dissected aorta. Here, we report anaesthetic management of a 36 year-old patient who developed acute type B aortic dissection at the 30th gestational week and whom was scheduled for caesarean section. Since haemodynamic stability could not be achieved despite nitroglycerine and esmolol infusions, together with invasive arterial monitoring, the decision for caesarean delivery was taken. A team of Cardiovascular Surgeons and an operating room were prepared because of the risks of aortic rupture and haemodynamic collapse during operation. A combined-spinal epidural anaesthesia was administered using 5 mg hyperbaric bupivacaine and 20 ?g fentanyl given at the L3-4 spinal level in the lateral position. After achieving T4 sensorial level, the operation proceeded and a baby weighing 1432 grams was delivered in 4 mins with a median sub-umbilical incision. Epidural patient controlled analgesia was applied to the patient during follow-up with medical treatment at postoperative period. Application of combined-spinal epidural anaesthesia with a combination of low dose local anaesthetics and an opioid with additional doses for insufficient sensorial levels is a suitable method for pregnant women with acute type B aortic dissection. © 2013 by Turkish Anaesthesiology and Intensive Care Society.
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    Anaphylactic shock in caesarean section
    (Turkish Anaesthesiology and Intensive Care Society, 2014) Şanli M.; Gülhaş N.; Akgül Erdil F.; Miniksar H.; Demiröz D.; Durmuş M.
    Following contact with the allergen, allergic reactions ranging from the urticaria to anaphylaxis can be seen. The incidence of anaphylactic reactions in patients with asthma and allergic rhinitis are in higher rates in general population. Perianaesthetic anaphylaxis are important. It may be severe and potentially associated with adverse outcomes unless urgently recognized and treated. Anaphylaxis has been reported in the literature, with commonly used substances like latex, antibiotics, ranitidine, colloid solutions. Development of anaphylactic shock due to use of oxytocin is a rare side effect. In this case report, we aimed to present the anesthetic management of anaphylactic shock in a pregnant women, without a history of allergic reaction, developed immediately after infusion of oxytocin during cesarean section.