Puerperal seizures: not the usual suspects

We present a case of puerperal seizures and neonatal flaccidity due to abuse and abrupt withdrawal from zolpidem, following an elective Caesarean delivery at term.Keywords: zolpidem, puerperal seizures, withdrawa

The effect of crystalloid versus medium molecular weight colloid solution on post-operative nausea and vomiting after ambulatory gynecological surgery - a prospective randomized trial.

UNLABELLED: ABSTRACT: BACKGROUND: Intravenous fluid is recommended in international guidelines to improve patient post-operative symptoms, particularly nausea and vomiting. The optimum fluid regimen has not been established. This prospective, randomized, blinded study was designed to determine if administration of equivolumes of a colloid (hydroxyethyl starch 130/0.4) reduced post operative nausea and vomiting in healthy volunteers undergoing ambulatory gynecologic laparoscopy surgery compared to a crystalloid solution (Hartmann\u27s Solution). METHODS: 120 patients were randomized to receive intravenous colloid (N = 60) or crystalloid (N = 60) intra-operatively. The volume of fluid administered was calculated at 1.5 ml.kg-1 per hour of fasting. Patients were interviewed to assess nausea, vomiting, anti-emetic use, dizziness, sore throat, headache and subjective general well being at 30 minutes and 2, 24 and 48 hours post operatively. Pulmonary function testing was performed on a subgroup. RESULTS: At 2 hours the proportion of patients experiencing nausea (38.2 % vs 17.9%, P = 0.03) and the mean nausea score were increased in the colloid compared to crystalloid group respectively (1.49 ± 0.3 vs 0.68 ± 0.2, P = 0.028). The incidence of vomiting and anti-emetic usage was low and did not differ between the groups. Sore throat, dizziness, headache and general well being were not different between the groups. A comparable reduction on post-operative FVC and FEV-1 and PEFR was observed in both groups. CONCLUSIONS: Intra-operative administration of colloid increased the incidence of early postoperative nausea and has no advantage over crystalloid for symptom control after gynaecological laparoscopic surgery

Cardiac Arrest Following Spinal Anaesthesia With Plain Bupivacaine for Caesarean Section

We describe cardiac arrest after plain bupivacaine spinal anaesthesia in a 28-year old woman who was admitted for an elective caesarean section. After preoperative evaluation and premedication she received a spinal anaesthesia in the L3-4 interspace with plain bupivacaine 0.5%. After being replaced in the supine position she reported difficult breathing. Radial pulse and blood pressure were no longer recordable. Cardiopulmonary resuscitation was started immediately, tracheal was intubated and the foetus delivered rapidly. After delivery of a healthy child the patient's pulse became palpable and circulation returned. The patient regained consciousness and the trachea extubated at the end of surgery. She was discharged from the ICU the next day without sequelae. In this paper the disadvantages of plain bupivacaine are discussed. Nigerian Medical Practitioner Vol. 50 (3&4) 2006: pp. 65-6

Outcome of Cardiopulmonary Resuscitation in the Intensive Care Units of a University Hospital

The purpose of this study is to evaluate the demographic characteristics of patients who suffered cardiac arrest in our ICUs and to identify those factors influencing outcome after resuscitation following cardiac arrest. We reviewed the records of all patients who underwent CPR in the two ICUs at the Georg-August University Hospital Goettingen, Germany from 1 January, 1999 to 31 December, 2003. During the study period 169 patients underwent CPR and 80 of the 169 patients survived to hospital discharge, giving a survival to hospital discharge rate of 47.3%. The initial monitored rhythm recorded at the time of arrest was asytole in 99 (58.6%) patients, ventricular tachycardia/fibrillation in 59 (34.9%) and pulseless electrical activity in 7 (4.1%) patients. The respective survival rates were 46 (54.8%), 31 (36.9%), and 5 (6.0%) to hospital discharge. Of the 80 patients that survived to hospital discharge 75 (93.8%)achieved good cerebral recovery (CPC 1 or 2) and were alert and fully oriented on discharge; 4 patients (5.0%)were severely disabled (CPC3), while 1 (1.2%) remained unconscious and was reported dead five days after discharged to another local hospital. Illness severity as assessed by SAPS 11score on admission was 38.8 16.0. None of our patients with >40 SAPS 11score 24 hours after CPR survived to be discharged from the ICU. Our study showed that nearly half the patients had cardiac arrest in our hospital ICUs had a favourable outcome despite initial rhythms that are traditionally associated with a poor outcome. This confirms that good results are achievable in these groups of patients. African Journal of Reproductive Health Vol. 10 (1) 2006: pp. 104-11