Biomedical subjects
Publications and source records attributed to K M Kuczkowski.
It is well known that symptoms of post-dural puncture headache (PDPH) are more likely if there has been a preceding PDPH. We herein present a patient who developed a PDPH following each of two dural punctures separated by 9 years.
Maternal use of social drugs in pregnancy continues to increase--worldwide. Although a great deal has been learned regarding the implications of illicit drug abuse in pregnancy (cocaine, amphetamines, hallucinogens), the use of social drug in pregnancy has received far less attention. This article reviews the consequences of the social drug use in pregnancy including ethanol, tobacco and caffeine and offers recommendation for anaesthetic management of these potentially complicated pregnancies.
History of previous post-dural puncture syndrome (PDPS) is a strong risk factor for another PDPS when spinal anesthesia is readministered to these patients. We herein report a case to show that this general rule may still apply even after the passage of 50 years.
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We present a case of a human immunodeficiency virus (HIV) positive, poly-substance abusing parturient who presented for an emergency cesarean section following recent cocaine and alcohol intake. Spinal anesthesia was selected for the abdominal delivery. 4 min after delivery of the fetus, the patient developed hypotension, intermittent runs of ventricular tachycardia, premature ventricular complexes and ST-segment elevation. Induction of general anesthesia, endotracheal intubation, intravenous lidocaine and phenylephrine were required to restore stability. At the end of surgery the patient was stable and was extubated. The ST-segment elevation returned to normal 45 min postoperatively. Her postoperative course was uneventful.
Ehlers-Danlos syndrome is a rare genetically transmitted connective tissue disorder, non-specific to pregnancy. Because of multi-organ involvement and varied presentations of this disease, no uniform anesthetic recommendations can be made. We report a case of a parturient with Ehlers-Danlos syndrome who presented in active labor with spontaneous rupture of membranes and footling breech presentation. She received single dose spinal anesthesia for an uneventful emergency cesarean section.
Cavernous transformation of the portal vein is a rare disorder resulting from extrahepatic portal vein thrombosis and development of collateral venous circulation. We report a case of a pregnant patient with congenital cavernous transformation of the portal vein associated with persistent consumptive coagulopathy and chronic thrombocytopenia. Single dose spinal anesthesia was safely conducted for an uneventful cesarean delivery.
Substance abuse, including that of cocaine, has crossed social, economic and geographic borders and remains one of the major problems facing society today. The prevalence of cocaine abuse in young adults (including women) has increased markedly over the past two decades. Nearly 90% of cocaine-abusing women are of childbearing age. Consequently it is not surprising to find pregnant women who abuse this drug, and numerous case reports of cocaine abuse in pregnancy have been published. The diverse clinical manifestations of cocaine abuse combined with physiologic changes of pregnancy, and pathophysiology of coexisting pregnancy-related disease might lead to life-threatening complications and significantly impact the practice of obstetric anesthesia. A complete understanding of the physiology of pregnancy, pathophysiology of pregnancy-specific disorders and anesthetic implications of cocaine abuse in pregnancy is essential to tailor a safe anesthetic plan for this high-risk group of patients.
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Explore the source record for details and available documents.