An 85-year-old man presented to A&E department with a bleeding, pulsatile mass within the left antecubital fossa. He reported a 3-month history of an increasing, painless swelling. He had a history of end-stage renal failure secondary to antiglomerular basement membrane disease. 14 years prior, he had a left brachiocephalic fistula created, which was ligated shortly after its creation due to Steal syndrome. Examination revealed a 10×15×10 cm pulsatile, non-tender mass with overlying ulceration in the left antecubital fossa. Arterial duplex demonstrated a pseudoaneurysm arising from the left distal brachial artery with a 9 mm neck. The patient underwent surgical exploration and repair. At surgery, a large brachial artery pseudoaneurysm at the site of the previous fistula ligation was found. The overlying ulcerated skin and pseudoaneurysm were excised en mass, and the arterial defect repaired by transection and end-to-end anastomosis. This is the first reported case of a brachial artery pseudoaneurysm occurring following arteriovenous fistula ligation.

This chapter discusses the anaesthetic management of the pregnant patient, for labour analgesia as well as surgical intervention. It begins with a description of the physiological and pharmacological changes of pregnancy. It describes methods of labour analgesia, including remifentanil, and epidural analgesia and its complications such as post-dural puncture headache. It describes anaesthesia for Caesarean section (both regional and general), failed intubation, antacid prophylaxis, post-operative analgesia, retained placenta, in utero fetal death, hypertensive disease of pregnancy (pre-eclampsia, eclampsia, and the hypertension, elevated liver enzymes, and low platelets (HELLP) syndrome), massive obstetric haemorrhage, placenta praevia and morbidly adherent placenta (placenta accreta, increta, and percreta), amniotic fluid embolism, maternal sepsis, and maternal resuscitation. It discusses co-morbidity in pregnancy, such as obesity and cardiac disease, and the patient who requires non-obstetric surgery while pregnant. It provides information on safe prescribing in pregnancy and breastfeeding.

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