Each year in the United Kingdom, nearly one-third of women giving birth will receive a central neuraxial block (CNB). The majority of postpartum neurological complications are secondary to intrinsic obstetric palsies. Despite this, neurological injury can occur following obstetric regional anesthesia. Any postpartum neurological deficit identified by the patient, anesthetist, midwife, or obstetrician should be investigated thoroughly. Prompt recognition and appropriate management of neurological complications is of the utmost importance in reducing the risk of permanent impairment. Anesthetists must recognize and coordinate the appropriate initial management for the complications associated with CNB in order to prevent permanent neurological damage.

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Background: Anaesthesia for caesarean section poses challenges unique to the obstetric patient due to changes in the airway and respiratory system. The choice of anaesthesia for caesarean section depends on various factors; however, general anaesthesia (GA) is necessary in certain situations. Supraglottic airway devices are an emerging method to secure the airway, especially in difficult situations. Of these devices, ProSeal laryngeal mask airway (PLMA) is designed to provide better protection of the airway. Use of PLMA has been reported to be successful as a rescue device in difficult intubation situations and in patients undergoing elective caesarean section without any complications. Hence, this prospective randomized study was designed to compare the use of PLMA with endotracheal tube (ETT) in patients undergoing elective lower segment caesarean section (LSCS). Material and Methods: Patients undergoing LSCS under GA belonging to the American Society of Anaesthesiologists (ASA) grades 1 and 2 were included. Patients with history of less than 6 h of fasting, known/predicted difficult airway, obesity, gastro-esophageal reflux disease, and hypertensive disorder were excluded. A standard anaesthesia protocol was followed. All patients received aspiration prophylaxis. The airway was maintained with either PLMA or ETT. The parameters including ease of insertion, adequacy of ventilation, hemodynamic changes at insertion and removal of device, and incidence of regurgitation and aspiration were noted. Statistical analysis: The data were analyzed by unpaired t-test, chi-square/Fisher's test. Results: Findings of the study indicated that PLMA was easy to insert (20.67 ± 6.835 s) with comparable insertion time to ETT (18.33 ± 4.971, P = 0.136) and adequate ventilation was achieved with very minimal hemodynamic changes seen with PLMA as compared to ETT at the insertion and removal of devices (P = 0.01). There was no incidence of regurgitation with the use of PLMA. The incidence of postoperative sore throat was minimal (6.7%) with PLMA (P < 0.05). Conclusion: PLMA appears to be a safe alternative to ETT for selected obstetric patients undergoing elective LSCS. A further study with a large group of patients is required to establish the safety of PLMA in obstetric patients.

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Cardiac surgery during pregnancy using cardiopulmonary bypass has a maternal mortality rate (MMR) of about 3-15%. Cardiopulmonary bypass, in addition, alters placental perfusion, which can increase infant mortality. Here, we report two cases of parturients with severe mitral stenosis, who developed acute mitral regurgitation (MR) after percutaneous transluminal mitral commissurotomy (PTMC) due to anterior mitral leaflet tear. They were posted for emergency mitral valve replacement (MVR) followed by cesarean section. Altering the routine cardiopulmonary bypass and anesthesia protocol resulted in a favorable maternal and fetal outcome.

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We describe the clinical course of two subsequent caesarean sections in the same parturient with congenitally corrected transposition of great arteries (CCTGA) complicated with complete heart block. CCTGA represents <1% of all forms of congenital heart diseases. In such patients, the hemodynamic effects of pregnancy and surgery may trigger systemic ventricular failure. In these parturients, ventricular dysfunction will also progress rapidly with subsequent pregnancies. The literature review showed no evidence describing the anesthetic management of these high-risk parturients. We used combined spinal epidural anesthesia uneventfully for both the caesarean sections in this patient. This case report will discuss the details of this rare congenital heart disease and the anesthetic management.

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A 24-year-old woman with a ventriculoperitoneal shunt in situ presented in the anesthesia clinic at 35 weeks of gestation for labor analgesia and anesthetic options for operative delivery, if required. The patient had been diagnosed with a space-occupying lesion in the posterior fossa. This was found to be neurocysticercosis for which she underwent surgery with the placement of a right ventriculoperitoneal shunt 14 years ago. The antenatal period was uneventful and the patient went into spontaneous labor at 37 weeks of gestation. The patient was given four injections of sterile water block labor analgesia after every 3 h and underwent a normal vaginal delivery. The postnatal period was uneventful and the mother and the baby were discharged after 5 days.

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A syncopal attack is a sudden loss of consciousness and muscle tone that may be due to various reasons. Vasovagal attack is one of the reason that leads to an unanticipated syncopal attack. A case is described in which a high level of anxiety and pain during insertion of the spinal needle caused a vasovagal attack. A 36-year-old female patient was posted for exploratory laparotomy. During the insertion of a 25-gauge spinal needle she became unconscious with the loss of muscle tone. The spinal needle got bent when it was still present inside the patient. The spinal needle was removed immediately with restoration of airway and circulation. A patient undergoing elective surgery with adequate anxiolysis can still have a rare chance of a syncopal attack.

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Anesthesia is a challenge in patients with congenital heart disease, especially during pregnancy and surgical delivery. A 23-year-old with a 34-week gestation, primigravida with atrioventricular (AV) canal defect was scheduled for a cesarean section. Preoperative transthoracic echocardiography (TTE) revealed a complete AV canal defect (Rastelli type II) with left-to-right shunt. Ventricular functions were normal. The patient was administered general anesthesia with endotracheal intubation, and a transesophageal echocardiography (TEE) probe was placed to monitor cardiac functions. The volume status of the parturient and the shunt fraction were continuously monitored with the echocardiography probe during the surgery. Minimal shunting at ventricular septal defect (VSD) was observed, as it was covered by the AV valve leaflets. The patient tolerated the procedure well and the trachea was extubated once she fulfilled the extubation criteria. Intraoperative TEE monitoring was a useful tool to understand and manage hemodynamic variations during cesarean section in the parturient with a complex cardiac lesion.

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Spinal anesthesia is the preferred technique of administering anesthesia for elective cesarean section (CS). Hypotension, failed spinal anesthesia, postdural-puncture headache, cauda equina syndrome are a few complications that may occur but neurological complications particularly aphonia are quite rare. The use of lipophilic opioids as adjuvants with local anesthetics are considered as culprit but the exact mechanism remains unidentified. We report such presentation in our patient and discuss the likely cause.

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Prostaglandin analogues are the most commonly used drugs by the obstetricians because of its favorable actions on the uterus and cervix. Although considered safe, this drug is associated with various adverse side effects. Here, we report two cases that became hemodynamically unstable after the administration of this drug.

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Anesthesiologists are often prevented from performing a follow-up of clinical cases due to the specific characteristics of their activity and may be blamed for complications not directly related to their interventions. Moreover, prudent strategies for communicating the diagnostic hypotheses are not always used, with relevant repercussions on the responsibilities imputed. Acute urinary retention (AUR) in pregnant women is a known complication of the postpartum period. Studies have reported the association between symptomatic AUR and neuraxial anesthesia/analgesia, instrumental labor, nulliparity, and episiotomy and have stated them to be the main risk factors of AUR. Severe neurological lesions resulting from the neuraxial approach, which is the main anesthesiologist intervention, is rare (0.0012-0.004%). In this study, we describe a case of a nulliparous pregnant admitted to the Obstetrics Department who developed AUR. We suggest that there must be a cautious attitude in the practice of medicine when allocating responsibilities, particularly in clinical syndromes that are not yet well-explained.

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