Maternal and fetal effects of continuous lumbar epidural analgesia for labour and delivery in pre-eclamptic patients.

The effects of continuous lumbar epidural analgesia for normal labour were studied in 28 women with pre-eclampsia and in 15 normal women who served as control. Maternal hemodynamics, acid-base and blood gas findings were examined. Newborn infants were assessed by Apgar Scores together with umbilical vein and artery blood gas and acid-base values. Mild significant reduction in maternal mean arterial blood pressure occurred in the pre-eclamptic patients which was corrected easily by intravenous crystalloid infusion. Maternal and newborn acid-base and blood gas findings showed no significant changes between the pre-eclamptic and control groups. Apgar Scores in both groups were good. The study indicates that continuous epidural analgesia is a useful form of therapy in the management of normal labour in women with pre-eclampsia.

Cimetidine - antacid combination as premedication for elective Caesarean section.

The effect of premedication with an oral antacid (magnesium trisilicate), oral cimetidine or a combination of both was studied in 80 patients undergoing elective Caesarean section. Twenty patients served as untreated controls. Seventy per cent of the patients were in the high risk range for acid aspiration pneumonitis (pH less than 2.5 plus gastric content volume greater than 25 ml). Antacid therapy was effective in raising pH but the gastric volume remained high in 50 per cent of the patients. Cimetidine was effective in decreasing gastric volume and raising pH but the pH was still less than 2.5 in two patients. None of the patients given the cimetidine-antacid combination were in the high risk range for acid aspiration pneumonitis. The combination of an oral dose of cimetidine 400 mg, three to four hours before the operation followed by 20 ml of magnesium trisilicate one hour preoperatively proved to be the most efficacious regimen for prophylaxsis against Mendelson's syndrome in elective Caesarean section. Recent reports have suggested that non-particulate antacids (e.g., sodium citrate) may be preferable to particulate antacids such as magnesium trisilicate.

Aspirated foreign bodies in the tracheobronchial tree: report of 250 cases.

During the last 14 years, 250 patients with aspirated foreign bodies in the tracheobronchial tree were admitted to Kuwait Chest Diseases Hospital. Ninety-six per cent of the cases were under 10 years of age and 38% gave a clear history of foreign body inhalation. The rest were diagnosed either clinically, from the chest radiograph findings or because of unexplained pulmonary symptoms. In 247 cases, bronchoscopy under general anaesthesia was successful in removing the foreign bodies. In only three cases was bronchotomy needed. Seventy per cent of the foreign bodies were melon seeds. Asphyxia and cardiac arrest occurred in four cases during bronchoscopy but the patients were successfully resuscitated. In 10 cases a tracheostomy was done before bronchoscopy and the removal of the foreign body, while in five it was needed after bronchoscopy. Fifteen patients developed late complications such as recurrent pneumonia or atelectasis of the lung. Early diagnosis and adequate treatment are essential to prevent pulmonary and cardiac complications and to avoid radical lung surgery.