P Pu ur rp po os se e: : To describe the anesthetic management and clinical course of a patient with peripartum cardiomyopathy. We highlight the frequent occurrence of thromboembolic morbidity in this group of parturients, emphasizing the need for early consideration of prophylactic anticoagulation.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 38-yr-old, diabetic, obese parturient was admitted with pulmonary edema and severe orthopnea at 31 weeks gestation. The respiratory rate was 44 breaths·min and rales were heard in both lung fields. The diagnosis of peripartum cardiomyopathy was made based on sinus tachycardia with no evidence of ischemia on the electrocardiogram, and global left ventricular hypokinesis with an ejection fraction of 40-45% noted on transthoracic echocardiography. Cesarean delivery was planned to improve maternal respiratory status and hemodynamics. General anesthesia with invasive monitoring was planned, and surgery and anesthesia proceeded uneventfully. Less than 24 hr postoperatively, she sustained a thrombotic cerebral infarct leaving her hemiparetic and dysarthric. Subsequent investigations revealed a thrombophilic state due to elevated anticardiolipin antibody.C Co on nc cl lu us si io on n: : General anesthesia is an acceptable option in parturients with heart failure secondary to cardiomyopathy. Thromboembolic complications are common, and early consideration should be given to prophylactic anticoagulation. Objectif

SummaryWe have previously demonstrated in a rat model that the lumbar intrathecal injection of 0.02 ml 6.3% magnesium sulphate, a concentration iso-osmolar with rat plasma, produces a state of spinal anaesthesia and general sedation which reversed completely after 6 h, without evidence of neurotoxicity, immediately or during the week thereafter. Using the same model and five groups of six animals in each, we administered the same volume and concentration of magnesium sulphate and compared its clinical effects with those of 0.02 ml 12.6% magnesium sulphate, 0.02 ml 2% lignocaine and 0.02 ml 0.9% sodium chloride solution, given as a series of 15 injections on alternate days for a period of 1 month. The animals were then killed and their spinal cords and meninges examined histologically. No significant differences were noted in the times of onset, durations of sensory and motor blockade and the times to full recovery throughout the entire period of 1 month's observation in the animals receiving intrathecal 6.3% magnesium sulphate. In the group receiving 12.6% magnesium sulphate, the time of onset of sensory and motor blockade was shorter and the duration of both parameters was significantly longer than in the former group. Full clinical recovery and resumption of normal eating and drinking took place in both groups throughout the entire series of 15 successive intrathecal injections. Identical, mild, uniform histopathological changes in the spinal cord were seen in all the five groups, including the group in which only the intrathecal catheter was implanted. The complete recovery and benign consequences of repeated intrathecal injections of iso-osmolar magnesium sulphate in a rat model indicate a lack of neurotoxicity and provide an impetus for further trials in larger animal species, before initial clinical trials of this substance, given intrathecally, in humans.Keywords Anaesthetics, local; lignocaine. Ions; magnesium. Anaesthetic techniques, regional; intrathecal. ...................................................................................... Correspondence to: Dr M. Bahar Accepted: 22 September 1996 The recent increased interest in the neurological effects of magnesium deficiency and a renewed concern with magnesium metabolism [1] prompted us to examine the results of intrathecal administration of magnesium sulphate (MgSO 4 ) in an animal model previously described by us [2]. We have also previously demonstrated in this same rat model that the intrathecal injection of a 0.02-ml bolus of 6.3% MgSO 4 , a concentration iso-osmolar with human and rat plasma [3][4][5], produced a state of spinal anaesthesia and general sedation lasting approximately 1 h. This

Indices of parasympathetic and sympathetic activity after neuraxial blockade in laboring patients can be obtained by analysis of both heart rate variability and blood pressure variability. The analysis by wavelet transform can discern changes in autonomic activity when values of blood pressure and heart rate do not vary significantly. Whether this technique could be used to predict and prevent hemodynamic compromise after neuraxial blockade merits further studies.