Obstetrics

Pre-eclampsia with fetal distress: A 34-year old gravida 3 para 2 female with pre-eclampsia requires emergency cesarean section for fetal distress. An epidural catheter was placed, but only gave unilateral pain relief when injected.

1. What is the possible mechanism?

2. Would you redose the catheter, or induce general anesthesia?

3. Is spinal anesthesia an appropriate alternative? Explain why or why not.

Post-operative jaundice

A 25-year old man who had a colon resection because of bleeding secondary to ulcerative colitis is jaundiced three days postoperatively. The surgeon writes in the chart that the jaundice is "secondary to anesthesia".

1. How will you proceed?

Numbness after brachial plexus block

One week after a supraclavicular brachial plexus block using 2-chloroprocaine in a patient having a carpal tunnel release, the patient returns with numbness in the fifth finger of the operated hand.

1. What is your differential diagnosis?

2. What are the probable causes?

3. What is your management?

4. What will you tell the patient?