Epidural blood patch improves postdural puncture headache in a patient with benign intracranial hypertension.

Benign intracranial hypertension (BIH) is a disorder of elevated resting intracranial pressure without associated intracranial abnormality. When medical therapy fails to halt visual impairments or recalcitrant headaches progress, lumbar dural puncture and cerebral spinal fluid (CSF) drainage procedures are instituted. The authors report on a patient with BIH in whom a severe postdural puncture headache (low CSF pressure syndrome) paradoxically developed after therapeutic CSF drainage. This postdural puncture headache was successfully treated with an epidural blood patch without complicating the patient's underlying BIH condition.

The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia.

BACKGROUND AND OBJECTIVES: The efficacy and safety of intravenous metoclopramide administered prophylactically before elective cesarean delivery under spinal anesthesia was studied. METHODS: In a double-blind, randomized fashion, 42 ASA Physical Status I-II parturients at term were assigned to receive either 10-mg intravenous metoclopramide or an equal volume of normal saline before induction of spinal anesthesia. The occurrence of nausea and/or vomiting recorded throughout the perioperative period until the patient was admitted to the recovery room. Neonatal acid-base status and neurobehavioral exams were obtained. RESULTS: Patients in the group receiving metoclopramide had a significantly lower incidence of nausea and vomiting both before and after delivery than the control group (14% versus 81% overall). All neonatal acid-base values were within normal limits and there were no significant differences in neurobehavioral exam results between the two groups. CONCLUSIONS: Metoclopramide administered before induction of spinal anesthesia for cesarean delivery appears to significantly reduce both pre- and postdelivery emetic symptoms without apparent adverse effects on mother or neonate.