Successful management of anaphylactic shock prior to elective cesarean delivery: a case report.

BACKGROUND: Anaphylactic cardiovascular collapse is complicated by aortocaval compression during pregnancy, exacerbated by neuraxial anesthesia. Despite recommendations to administer perioperative antibiotics before anesthesia, common practice in Japan involves administering them after anesthesia induction. We report a case of possible antibiotics-induced anaphylaxis just before anesthesia for cesarean delivery. CASE PRESENTATION: A 24-year-old woman at 37 weeks of gestation presented for a scheduled repeat cesarean under spinal anesthesia. After starting administration of cefazolin prior to anesthesia, she developed anaphylactic symptoms. Hypotension refractory to adrenaline necessitated conversion to an emergency cesarean section under general anesthesia. A neonate was delivered with favorable Apgar scores. Post-delivery, the mother's hemodynamics stabilized significantly. Elevated plasma tryptase confirmed anaphylaxis. Both mother and infant were discharged without further complications. CONCLUSIONS: This case emphasizes the importance of administering prophylactic antibiotic before anesthesia in mitigating severity of shock induced by anaphylaxis and the crucial role of prompt emergency cesarean in achieving successful outcomes.

Analgesia and Anaesthesia Management of Labour and Caesarean Delivery for a Parturient with Paramyotonia Congenita.

Anaesthetic management in paramyotonia congenita (PC) or 'paradoxical myotonia' poses perioperative challenges to the anaesthesiologists both in obstetric and non-obstetric surgical patients. There are only a few case reports on the anaesthesia management particularly in the obstetric population. Therefore, we aimed to present the management of analgesia of labour and emergency caesarean delivery for a 26-year-old parturient with PC.

Refractory hypokalemia during barbiturate coma therapy used for treating refractory intracranial hypertension in traumatic brain injury.

Barbiturate coma therapy (BCT) is a choice treatment for refractory intracranial hypertension after all surgical or medical managements have failed to control the intracranial pressure (ICP). It helps to reduce cerebral blood flow, cerebral metabolic rate of oxygen consumption and ICP. However, this therapy can also cause many complications. One of the underreported, but life-threatening complications is refractory hypokalemia, which can lead to subsequent rebound hyperkalemia after sudden cessation. We report our experience of managing unusual complication of refractory hypokalemia during BCT with thiopentone in postdecompressive craniectomy patient.