Non-targeted serial epidural blood patches for the treatment of intracranial hypotension headache during late pregnancy: a case report.

Intracranial hypotension can cause persistent and severe orthostatic headaches. It is often the result of cerebrospinal fluid leakage secondary to iatrogenic causes. It can also happen spontaneously. Diagnosing and managing severe orthostatic headaches associated with intracranial hypotension can be challenging, particularly during late pregnancy. This case describes a parturient at 30 weeks' gestation who presented with severe headaches due to intracranial hypotension caused by dural defects and cerebrospinal fluid venous fistula. She was managed with serial non-targeted epidural blood patching as a bridging remedy. This allowed further fetal maturity before delivery and definitive management of the dural leakage after delivery.

Readiness to practice: expressed views of the newly registered nurses' in medical/ surgical settings at public hospitals across Trinidad

Objective: The purpose of this study was to determine the factors affecting practice among newly registered nurses' in medical/surgical settings at public hospitals across Trinidad and Tobago. Design and Methodology: A descriptive cross-sectional study was done which documented the responses of the newly registered nurses at five hospitals in Trinidad. 163 of the estimated 224 new nurses volunteered and were recruited by filling out the researchers'- designed questionnaire on the 3 areas affecting their practice (knowledge, support and experience). SPSS was used for the data analysis. Results: The overall response rate was 69.7%. Results show that the new nurses have a mean scores of 3.64 for Knowledge of a maximum of 5, followed by their Experience (3.57) and support 3.29 from a maximum of 5. Also their scores in experience were significantly related to their education and Hospital of employment (p≤0.05); while their scores on support were significantly associated with their School of training (p≤0.05); period of employment (p≤0.05); and Hospital of employment (p≤0.05). Also their mean scores on Experience was significantly related to their hospital of employment (p≤0.05). Conclusion: The findings showed that support received by the newly registered nurses was the factor that mostly affected their practice. Mentorship for newly registered nurses is a recommended tool to enhance their practice following Benner's theory which explains how to transition newly registered nurses from novice to expert in practice.

S100ß in newborns after C-section with general vs. epidural anesthesia: a prospective observational study.

BACKGROUND: Preclinical evidence suggests that general anesthetics can dose dependently induce neurodegeneration in the developing brains of animals which can be reliably determined by measurement of blood S100ß, but this correlation remains unclear in humans. We hypothesized that S100ß would not be increased in cord arterial blood of fetuses exposed briefly to general anesthetics during a C-section, compared with epidural anesthesia. METHODS: A prospective observational clinical study comparatively measured changes of brain damage biomarker S100ß ratio of umbilical artery over vein (changes after fetus circulation) immediately after delivery under C-section with either epidural or general anesthesia. Newborn blood gas measurements, APGAR scores, and maternal well-being were also compared. RESULTS: Compared with epidural anesthesia, general anesthesia resulted in the lower S100ß ratio of umbilical artery over the vein (medium 2.64 [quartiles 1.39, 3.45] vs. medium 1.59 [quartiles 0.88, 2.01], P = 0.031), without changing the S100ß level in the vein of the mother. There was no significant difference between general and epidural anesthesia when comparing other maternal and newborn parameters. CONCLUSION: S100ß levels in newborn after C-section is lower with general anesthesia than epidural anesthesia, with unclear mechanisms.

Cerebrovascular reactivity across the menstrual cycle in young healthy women.

This study evaluated the relationship of cerebrovascular reactivity in young healthy women with changes in concentrations of circulating ovarian hormones throughout the menstrual cycle. Nineteen healthy nulliparous, right-handed, regularly menstruating women (age 23-25 years) underwent color-coded duplex sonography of the common (CCA), internal (ICA) and external (ECA) carotid arteries on both sides. Mean blood flow velocity values measured before and ten minutes after intravenous administration of 1000 mg acetazolamide (ACE) were assessed in relation to the serum concentration of estrogen and progesterone on days 5, 13 and 26 of the cycle. After ACE administration flow velocity in the right CCA and ICA increased by 23% and 35% on day 5, 12% and 31% on day 13 and 30% and 47% on day 26 respectively, and the changes were significantly larger on the right side (F=6.793 and F=4.098 respectively; both p<0.05). Changes in blood flow velocity in the right CCA and ICA after ACE injection were significantly associated with ovarian hormone concentrations (F=3.828, P=0.028 and F=3.671, P=0.032 respectively). We conclude that cerebrovascular reactivity changes across the menstrual cycle are associated with ovarian steroid hormone changes, and are asymmetric. The results imply that vasculature of the right hemisphere may undergo cyclic vasodilation across the menstrual cycle and this effect should be considered in studies of cerebrovascular reactivity in women with migraine and mood disorders.