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Biomedical subjects

Krzysztof M Kuczkowski

Publications and source records attributed to Krzysztof M Kuczkowski.

At least 19 recordsLinked to original sources
PubMed2006

Uneventful epidural labor analgesia and vaginal delivery in a parturient with Arnold-Chiari malformation type I and sickle cell disease.

Arnold-Chiari malformation is a disorder of the hindbrain which can lead to altered craniospinal pressures and abnormal flow of cerebrospinal fluid. The possibility of increased intracranial pressure imparts significant risk during labor and delivery, and has led to concern over the use of neuraxial anesthesia. Sickle cell disease is a disorder of abnormal hemoglobin that is prone to sickling under stressful conditions. The physiologic and metabolic changes associated with pregnancy and labor can precipitate sickling, which increases risks for both the mother and the fetus. Vaso-occlusive pain crisis in a parturient with sickle cell disease has been shown to improve with the initiation of neuraxial anesthesia. We present the first reported case of a parturient with both Arnold-Chiari malformation type I and sickle cell disease who presented to labor and delivery with acute pain crisis and who subsequently received epidural labor analgesia and underwent successful vaginal delivery. We include a discussion of the risks associated with pregnancy, labor, neuraxial anesthesia, and delivery in a patient with Arnold-Chiari malformation type I and sickle cell disease.

Adult↗
PubMed2006

Labor pain and its management with the combined spinal-epidural analgesia: what does an obstetrician need to know?

Most women rate pain of childbirth as the most painful experience of their lives. Lumbar epidural analgesia is widely considered as the most effective method of providing pain relief in labor. However, lumbar epidural analgesia for labor is not a standard (generic) procedure and many technical modifications have been developed and introduced into clinical practice over time. The combined spinal-epidural labor analgesia technique (CSEA) has attained widespread popularity in obstetric anesthesia worldwide. The onset of analgesia is rapid and reliable, and maternal satisfaction is very high. While there still remains some concern about dural puncture, and while the pros and cons of using the CSEA as opposed to traditional epidural for labor pain are still being debated, it appears certain that the CSEA technique offers many unique advantages to the pregnant woman.

Analgesia, Obstetrical↗
PubMed2006

Labor analgesia for pregnant women with spina bifida: what does an obstetrician need to know?

Neural tube defects, with a birth incidence of approximately 1/1,000, are the second most common (after congenital heart defects) type of congenital birth defects. The most common clinical presentations of neural tube defects include spina bifida and anencephaly. Spina bifida, which is one of the most common, serious malformations of human structure, is a general term that encompasses a wide range of malformations. With constant improvements in medical and surgical care, and subsequent decreases in spina bifida-related mortality and morbidity many women with these defects are reaching childbearing age. Provision of labor analgesia in pregnant women with spina bifida continues to be a challenge. This manuscript attempts to provide a synopsis of the available literature on labor analgesia in pregnant women with spina bifida.

Analgesia, Obstetrical↗
PubMed2006

Labor analgesia for the parturient with prior spinal surgery: what does an obstetrician need to know?

Administration of lumbar epidural analgesia in a parturient with previous spinal surgery presents a unique challenge to the anesthesiologist. These challenges (difficulties) range from inability to identify the epidural space, multiple attempts before catheter insertion, vascular trauma, and/or subdural local anesthetic injection to accidental dural puncture. The literature documenting management of labor analgesia in pregnant women with prior spinal surgery is limited to a handful of case reports. This author is not aware of any other review articles in English literature discussing special considerations for labor analgesia in parturients presenting with history of prior spinal instrumentation.

Analgesia, Epidural↗
PubMed2006

Labor analgesia for the parturient with herbal medicines use: what does an obstetrician need to know?

The use of herbal medicines in the developed world is widespread, and increasing. Herbal medicines, which include a wide spectrum of substances ranging from home-made teas to the national regulatory bodies-approved medicinal substances, are defined as plant-derived products that are used for medicinal and/or nutritional purposes. The use of herbal self-therapy is common in pregnancy, with many parturients consuming more than one agent at a time. Despite widespread use there has been surprisingly little research into the outcomes or the potential risks of using herbal therapies during pregnancy. As epidural analgesia is the most popular form of pain relief in labor, the potential for herbal remedies-related alterations in maternal hemodynamics (e.g., hypertension, tachycardia), and increased bleeding tendencies (e.g., spinal-epidural hematoma) remain a significant concern. Obstetricians and obstetric anesthesiologists must be familiar with the effects of herbal medicines and should specifically inquire about the use of herbal medicines during prenatal/preanesthetic assessment. This review article attempts to summarize current data on special considerations for labor analgesia in parturients with herbal medicines use.

Analgesia, Obstetrical↗
PubMed2006

The management of accidental dural puncture in pregnant women: what does an obstetrician need to know?

Post-dural puncture headache (PDPH) also known as spinal (or post-spinal) headache still remains a disabling complication of needle insertion into the subarachnoid space. Pregnant women are at particular risk of dural puncture, and the subsequent headache, because of sex, young age, and the widespread application of regional anesthesia. Accidental dural puncture complicating epidural anesthesia varies in incidence from 0.19 to 4.4%. The incidence of epidural needle-induced PDPH headache in pregnant women has been reported to range 76-85%. The classic symptoms of PDPH consist of photophobia, nausea, vomiting, neck stiffness, tinnitus, diplopia, and dizziness in addition to the often, severe cephalgia. This article reviews the current literature on the pathophysiology, incidence, prevention, and treatment of PDPH in pregnant women.

Anesthesia, Obstetrical↗
PubMed2006

Labor analgesia for the parturient with spinal cord injury: what does an obstetrician need to know?

Each year more than 2,000 women of childbearing age in the United States alone sustain a spinal cord injury (SCI). As a result of increased survival rates in women with SCI the number of parturients with SCI is increasing. The literature documenting peripartum obstetric and anesthetic management of pregnant patients with SCI is very limited. Any parturient with SCI whose level of transection is at the level of T6 or higher is at risk for acute autonomic hyperreflexia (AHR) as a result of uterine contractions. Expeditious induction of labor analgesia may prevent or ameliorate peripartum complications (including AHR) in laboring parturients with SCI.

Analgesia, Obstetrical↗
PubMed2006

Labor analgesia for the parturient with lumbar tattoos: what does an obstetrician need to know?

Tattoos-ancient forms of permanent body ornamentation (body art) have today become popular fashion accessories worldwide. More than 50% of all tattoos are being done on women. In the recent years body tattooing in unconventional sites (e.g. lumbar and/or sacral area, lower abdomen, breast, and buttocks) has gained increasing popularity among young women (including in pregnancy). Although, the potential hazards of regional anesthesia in patients with lumbar tattoos remain controversial it may seem prudent to avoid a hollow needle insertion (possible tissue entrapment in its bore as the needle passes to the deeper structures) through a tattoo for neuraxial blocks. This author is not aware of any other review articles in English literature discussing implications, and complications of labor analgesia in parturients presenting with lumbar tattoos.

Analgesia, Epidural↗
PubMed2006

Labor analgesia for the parturient with neurological disease: what does an obstetrician need to know?

Several neurological disorders including multiple sclerosis, myasthenia gravis, epilepsy, spinal cord injury, and subarachnoid hemorrhage are encountered with increasing frequency in pregnant women worldwide. Although there is absence of uniform anesthetic guidelines for pregnant patients with most of these (and other) neurological disorders, and the decision whether or not to administer regional anesthesia is based on an individual risk-to-benefit ratio on a case-by-case basis, few of these disorders contraindicate the use of neuraxial anesthesia. This article attempts to review the specific concerns for administration of labor analgesia posed by multiple sclerosis, myasthenia gravis, epilepsy, paraplegia and subarachnoid hemorrhage.

Analgesia↗