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Biomedical subjects

W Camann

Publications and source records attributed to W Camann.

At least 19 recordsLinked to original sources
PubMed2006

Coronary arterial air embolus occurring during cesarean delivery.

We present a case of a severe systemic (paradoxical) air embolism occurring during spinal anesthesia for cesarean delivery in an otherwise healthy 35-year-old parturient. Uncomplicated spinal anesthesia and satisfactory surgical anesthesia were obtained; no sedatives were used and the patient was awake and alert and tolerating the procedure well. Immediately following infant and placental delivery (approximately 25 min after the spinal anesthetic was induced) the patient had acute onset of markedly decreased mental status, profound ventricular ectopy and labile blood pressure. The event lasted for approximately 10 min with spontaneous resolution. Neurologic status returned to normal by the end of the surgery, but electrocardiogram findings in the immediate postoperative period were consistent with myocardial ischemia and serial cardiac troponin levels confirmed myocardial injury. On postoperative day 1, an echocardiogram demonstrated the presence of a patent foramen ovale. The events in this case are likely to be due to paradoxical coronary and cerebral air embolism.

Adult↗
PubMed2005

Hyperventilation-induced tetany associated with epidural analgesia for labor.

We report a case of painful carpo-pedal spasm associated with the initiation of epidural analgesia for labor. The patient, an otherwise healthy primigravida in early labor at term, was experiencing severe hyperventilation as a result of inappropriate use of the Lamaze breathing technique. Bilateral carpo-pedal spasm occurred, and produced severe pain. Resolution of symptoms coincided with onset of effective epidural labor pain relief. A diagnostic challenge was presented to the anesthesiologist, as the symptoms could have been consistent with subdural block, local anesthetic toxicity, high sensory level of analgesia or eclamptic neuro-excitation activity.

Adult↗
PubMed1996

Automated ST-segment analysis during cesarean delivery: effects of ECG filtering modality.

STUDY OBJECTIVES: To determine the effect of different electrocardiographic (ECG) filtering modalities on ST-segment changes during cesarean delivery. We compared the use of narrow and standard bandwidth ECG filtering modes in assessing ECG-detected ischemic changes in healthy patients undergoing routine, elective cesarean delivery. DESIGN: Prospective, nonrandomized clinical trial. SETTING: Academic medical center. PATIENTS: 20 healthy parturients undergoing elective cesarean delivery with regional anesthesia. INTERVENTION: Continuous 5-lead ECG monitoring was performed in all 20 study parturients. The same incoming ECG signal was divided by a special cable and displayed on two Marquette 7010 monitors. Leads I, II, and V5 were analyzed. One of the monitors filtered the signal with a 0.07 to 100 Hz filter (DIAG), the other with a 0.3 to 40 Hz filter (MON). The ST segment was analyzed continuously by electronic comparison with a template established as a baseline at the beginning of the case. This continuous output was led in digital form every 15 seconds to an IBM PC computer for data analysis. MEASUREMENTS AND MAIN RESULTS: In each of the leads analyzed, the mean MON versus DIAG different showed a bias, with MON showing consistently lower (ie, more negative) readings than DIAG. Using different criteria for ST depression (> 0.25, > 0.5, or > 1.0mm), we categorized patients as showing more ST depression on either MON or DIAG. With the 0.25 mm criterion, ST depression was identified significantly more often in MON then DIAG in leads H and V5 (p < 0.05). Using the other criteria, the differences were similar, but were not statistically significant. In general, very few instances of ST depression were identified in lead I. No patient had sequelae indicative of intraoperative myocardial ischemia, such as chest pain, dyspnea, persistent ectopy, or hemodynamic instability. CONCLUSIONS: In patients at low risk for myocardial ischemia, narrow bandwidth (monitor mode) ECG filtering reveals greater degrees of ST-segment depression than does standard (diagnostic mode) ECG filtering. Studies examining ST-segment phenomena would be facilitated by including a description of the ECG filtering-technique.

Angina Pectoris↗
PubMed1996

Electrocardiographic changes during cesarean section: a review.

Recently, various authors have noticed and studied the phenomenon of ST segment depression during cesarean section. We have undertaken a review of the various postulated etiologies including venous air emboli, hormonal influences, autonomic nervous system influences tachycardia, postural influences, hypokalemia, hyperventilation, and myocardial ischemia. It appears that ST segment depression during cesarean section is almost certainly a multifactorial phenomenon. There is evidence that some myocardial dysfunction occurs during these episodes. Additionally, the hormonal milieu, tachycardia, and the postural component probably contribute to the phenomenon. Venous air emboli, hypokalemia, and hyperventilation probably have a minimal role. The sympatholysis produced by regional anesthesia is of unclear significance. It is important to note the apparent lack of morbidity associated with these changes.

Journal Article↗
PubMed1995

Meralgia paresthetica in the parturient.

Meralgia paresthetica is a common sensory mononeuropathy of the lateral femoral cutaneous nerve which occurs in pregnancy as well as in many other conditions. The most likely etiology in pregnancy is entrapment of the nerve as it passes around the anterior superior iliac spine or through the inguinal ligament. Onset of symptoms, most commonly numbness on the anterolateral thigh but possibly including burning, tingling, and other paresthesias, can occur at any time during pregnancy or immediately after labor and delivery. Symptoms, which are almost always self-limited, can be disturbing to the parturient and may interfere with normal daily activities. If the physician is not familiar with this disorder and the involved anatomy, the search for a diagnosis can result in unneccessarily expensive tests and consultations. A careful neurologic examination is usually all that is necessary for diagnosis. When the diagnosis of meralgia paresthetica is made prior to childbirth, this should not contraindicate the use of regional anesthesia, if necessary, for labor and delivery. The mother should be reassured that the symptoms usually resolve following delivery. Conservative therapy such as minimizing periods of standing, eliminating tight clothing and using oral analgesics may contribute to recovery. As a last resort surgical therapy has been shown to be effective in some cases.

Journal Article↗