PubMed · 14727271
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Craig Palmer. Exploring the subdural space.. https://doi.org/10.1016/j.rapm.2003.11.003
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OBJECTIVE: In this prospective study, we examined the influence of either segmental epidural anesthesia with bupivocaine hydrochloride or general anesthesia with sevoflurane on serum bilirubin levels and jaundice in neonates born with caesarean section. MATERIALS AND METHODS: The patients at 38-40 weeks were included into this prospective study. General anesthesia group (sevoflurane); Group A, (n=66) and segmental epidural anesthesia group (bupivocaine hydrochloride); Group B, (n=76) underwent caesarean section under elective circumstances. Neonatal serum bilirubin levels were determined at the ages of 24 h and 5 days in 142 infants. The sexuality, weight, 5th minute APGAR scores, hematocrit levels of the neonates were recorded. The neonates who needed phototherapy were also noted. The results in Group A and Group B were compared. RESULTS: There was no significant difference on bilirubin levels between two groups and the incidence of hyperbilirubinemia did not differ statistically (p>0.05). The percent of the newborns who needed phototherapy displayed no significant differences between the deliveries by caesarean section under general or segmental epidural anesthesia. CONCLUSION: Our findings support the clinical studies which have not demonstrated an association between different anesthesiologic strategies and neonatal jaundice.
Use of neuraxial block in a patient with motor neuron disease is controversial. We describe the anaesthetic management by epidural anaesthesia of a patient with Kennedy's disease, a rare lower motor neuron disease characterized by progressive weakness and wasting of limbs and bulbar muscles. The perioperative course was uneventful, and there was no exacerbation of neurologic signs or symptoms. We suggest that a patient with Kennedy's disease may be successfully managed by epidural anaesthesia for surgical internal urethrotomy.
BACKGROUND: Autism is considered to have a genetic basis, although exposure to certain stimuli in the prenatal period has been implicated to be causal in some cases. Some investigations have shown an association with obstetric complications but findings have been inconsistent owing to differences in sampling and methods. OBJECTIVE: To examine the association of obstetric factors with autism spectrum disorders for a cohort of children, using obstetric data contained in a statutory database collected at the time of birth. DESIGN: Subjects born in Western Australia between 1980 and 1995 and diagnosed with an autism spectrum disorder by 1999 were included as cases (n = 465). Siblings of the cases (n = 481) and a random population-based control group (n = 1313) were compared with the cases on obstetric information contained in the Maternal and Child Health Research Database of Western Australia. RESULTS: Compared with control subjects, cases had significantly older parents and were more likely to be firstborn. Case mothers had greater frequencies of threatened abortion, epidural caudal anesthesia use, labor induction, and a labor duration of less than 1 hour. Cases were more likely to have experienced fetal distress, been delivered by an elective or emergency cesarean section, and had an Apgar score of less than 6 at 1 minute. Cases with a diagnosis of autism had more complications than those with pervasive developmental disorder not otherwise specified or Asperger syndrome. Nonaffected siblings of cases were more similar to cases than control subjects in their profile of complications. CONCLUSIONS: Autism is unlikely to be caused by a single obstetric factor. The increased prevalence of obstetric complications among autism cases is most likely due to the underlying genetic factors or an interaction of these factors with the environment.