Viscoelastic testing guided coagulation management in factor VII deficiency for spinal anaesthesia and caesarean section.

The risks and benefits of spinal anaesthesia must be assessed in patients with coagulation disorders. A woman in her 20s with congenital factor VII (FVII) deficiency (31%) was admitted at 38 weeks for caesarean delivery. A rotational thromboelastometry (ROTEM) analysis showed normal coagulation and spinal anaesthesia was performed safely. A repeated ROTEM analysis after haemostasis and uterine closure showed normal coagulation without fibrinolysis. No prophylactic FVII was administered, resulting in a cost savings of US$12 884. FVII level did not predict bleeding or fibrinolysis and FVII and tranexamic acid were not indicated.

Intrathecal hyperbaric bupivacaine dose response in postpartum tubal ligation patients.

BACKGROUND AND OBJECTIVES: Because of its short duration, hyperbaric lidocaine has been a popular intrathecal drug to provide anesthesia for postpartum tubal ligation (PPTL). However, reports of transient symptoms associated with its use have prompted the search for alternative intrathecal local anesthetics for short procedures. Hyperbaric bupivacaine is rarely associated with transient neurologic symptoms, and we designed this study to determine the optimal dose of bupivacaine for PPTL that assures adequate sensory block and allows the patient the shortest recovery time. METHODS: Forty American Society of Anesthesiologists (ASA) I-II patients undergoing spinal anesthesia for PPTL were randomly assigned to receive 5.0, 7.5, 10.0, or 12.5 mg hyperbaric bupivacaine in the right lateral position. RESULTS: Despite sensory block above T-8 in all groups, 4 of the 5 patients in the 5-mg group developed blocks insufficiently dense for surgery and required general anesthesia. Failed spinals occurred evenly in the remaining groups. Motor regression was significantly more rapid with decreasing doses of bupivacaine. Time in the postanesthesia care unit (PACU) was shorter in the 7.5-mg group. CONCLUSIONS: Hyperbaric bupivacaine 7.5 mg injected in the lateral position provides adequate surgical anesthesia for PPTL with a minimal duration of motor block and recovery time.