Any anaesthetic technique either regional or general has potential for complications.

Any anaesthetic technique either regional or general has potential for complications. practice. Keywords: Complications of anaesthesia general anaesthesia regional anaesthesia obstetric anaesthesia practice Omecamtiv mecarbil INTRODUCTION Obstetric anaesthesia is generally considered to be one of the higher-risk areas of anaesthetic practice. Changes in maternal physiology during pregnancy and the care of both mother and foetus present unique challenges to the obstetric anaesthetists. Although new systems and technologies are developing to provide consistent and safe anaesthetic care to pregnant mothers the modern-day obstetric anaesthetist has to also grapple Omecamtiv mecarbil with issues related to changing population characteristics including maternal obesity advanced maternal age and an increased complexity of medical diseases (including cardiac diseases) which may affect women with a reproductive potential. Both regional and general anaesthesia carry with them the potential for complications some of which although rare may be serious life-threatening and/or permanently disabling. Complications of regional anaesthesia and general anaesthesia that are commonly encountered during obstetric anaesthesia are discussed in this review. REGIONAL ANAESTHESIA IN OBSTETRICS In Great Britain a number of high-profile legal cases in the 1950s concerning major complications of neuraxial techniques led to its decline for more than two decades.[1] However over the last 30 years the use of regional anaesthesia is rapidly increasing. One study from the UK has shown that the rate of regional anaesthesia for elective caesarean section (CS) rose from 69.4% in 1992 to 94.9% in 2002 where spinal anaesthesia was used for 86.6% of the cases.[2] Various factors like improved maternal and foetal safety with regional anaesthesia[3] and confidential enquiry into maternal deaths due to general anaesthesia have been responsible for the increased use of regional anaesthesia.[4] Although serious complications are uncommon with regional anaesthesia they must be considered and should be discussed with the patient. COMPLICATIONS OF REGIONAL ANAESTHESIA (A) Complications with central neuraxial blockades Central blockades provide excellent labour analgesia and safe anaesthesia for CS and Omecamtiv mecarbil are associated with a low incidence of severe complications. The following complications can occur with central neuraxial blockades (CNB). Post-dural puncture headache (PDPH): PDPH is a common complication of neuraxial blockade.[5] Parturient constitutes the highest risk category the reported incidence in these patients varying between 0 and 30%.[6] PDPH is related to the size as well as the Mmp10 type of the spinal needle used and it is progressively reduced with the use of thinner Quincke-type spinal needles.[7] Pencil point needles have a lower incidence of PDPH than cutting needle tip designs.[8] PDPH is a complication that should Omecamtiv mecarbil not be treated lightly. There is the potential for considerable morbidity due to PDPH.[9] It is reported that untreated PDPH leads to subdural haematoma[10] and even death from bilateral subdural haematomas.[11] Therefore anaesthesiologists are advised to prevent PDPH by optimizing the controllable factors like spinal needle size as well as shape while conducting spinal anaesthesia.[12] PDPH is usually self-limiting and spontaneous resolution may occur in few days. Therefore the authors recommend approximately 24 h of conservative therapy. Various pharmacological (e.g. Methylxanthines ACTH Caffeine) and interventional measures (e.g. epidural saline/dextran) are available to treat PDPH; epidural blood patch (EBP) has a 96-98% success rate and has been recognized as the definitive treatment for PDPH.[13 14 Prophylactic EBP is also gaining acceptance.[15] Neurological complications[16]: Serious neurological complications related to regional anaesthesia are fortunately very rare. The incidence of permanent or transient neurologic complications after CNB is estimated to be between 1/1 0 and 1/1 0 0 Direct trauma to the nervous tissue may occur at the level of the spinal cord nerve root or peripheral nerve. The epidural needle or spinal needles may touch the nerve roots or may directly injure the spinal cord. Scott and others monitored 505 0 epidural blocks in parturients finding only 38.