The incidence of rheumatic mitral stenosis is grossly reduced in India. Still, among heart disease complicating pregnancy, rheumatic mitral stenosis occupies a greater segment. The unique physiological changes in pregnancy and the pathological impact of mitral stenosis over pregnancy and labour are discussed in detail. A multidisciplinary approach in the diagnosis and management reduces the mortality and morbidity during peripartum. The labour analgesia technique and the evidence-based regional and general anaesthesia techniques are discussed at length in this article.

The transversus abdominis plane block is a regional anesthesia technique that has become popular. Being a relatively simple procedure, the TAP block has an excellent safety profile and major complications are rare. We present a case of transient femoral nerve palsy occurring after a TAP block with involvement of the sacral plexus for a patient who had undergone a caesarean section.

Surgical embolectomy is a viable option for massive PE, and aerosolized epoprostenol can be used as adjuvant treatment for right ventricular strain secondary to acute pulmonary hypertension.

IntroductionCervical radiculopathy is a common condition affecting many people each year. The efficacy of cervical epidural steroid injection for patients that have not responded to conservative treatment has been demonstrated. Even with confirmatory radiocontrast dispersion indicating correct presence in the epidural space, there still may be rostral spread of steroid and local anesthetic resulting in an unusual presentation of symptoms and potentially life threatening complications.Case PresentationWe present the case of a 52-year-old male presenting for a right sided C6-C7 epidural steroid injection. The epidural space was identified and a Tuohy needle was advanced using loss of resistance technique. Isovue contrast was used for needle localization and after confirmation of the presence of the contrast in the epidural space, dexamethasone and lidocaine were injected to the area without any complications. Five minutes after arrival to the PACU, the patient developed a constellation of symptoms including inability to swallow, vertigo, and horizontal nystagmus which required reassurance and vigilant monitoring.ConclusionsInterventional pain physicians must be cognizant that even with confirmatory epidural radiocontrast dispersion, there still may be inadvertent uptake of steroid and local anesthetic rostrally resulting in an unusual presentation of symptoms and potentially life threatening complications. Potential reasons for the rostral spread include inadvertent subdural or intrathecal injection.