Multiple pharmaceutical products contain excipients, or additive chemicals, to improve stability, bioavailability, antimicrobial activity, or palatability. Two of the most common excipients are propylene glycol and parabens. We report the successful anesthetic management of a patient with idiosyncratic reactions to prescribed and over-the-counter medications containing propylene glycol and parabens.

The teratogenicity of thalidomide has been known since the early 1960s [1]. Thalidomide is currently used world wide, including the United States, to treat erythema nodosum leprosum, multiple myeloma, refractory Crohn's disease, aphthous stomatitis and HIV wasting syndrome. New cases of thalidomide phocomelia are being reported as well. We report a case of the anesthetic challenges of a 23 year-old parturient with thalidomide phocomelia and review the important anesthetic challenges it presents. Spontaneous vaginal delivery under continuous lumbar epidural was achieved in this challenging patient. However, it required careful planning for reliable intravenous access and the use of magnetic resonance imaging (MRI) of her pelvis and lumbar spine.

Native American Myopathy (NAM) is an inherited, malignant hyperthermia-susceptible myopathy associated with abnormal craniofacial development and neuromuscular scoliosis. There is scant NAM anesthetic literature and, to our knowledge, no existing publications describing the anesthetic management of a NAM parturient. The constellation of symptoms of NAM in the parturient presents a number of challenges to the obstetric anesthesiologist, including difficult airway associated with craniofacial abnormalities and pregnancy, malignant hyperthermia susceptibility, and possible difficult neuraxial block. In this report, we present the anesthetic management of a parturient with NAM and previous extensive posterior spinal fusion undergoing cesarean delivery under general anesthesia. (A&A Practice. 2021;15:e01541.

A multidisciplinary approach among the obstetric, hematological, pharmaceutical, nursing, and anesthetic team proved essential for the successful peripartum management of a gravida 3, para 2 female with a new diagnosis of congenital hypofibrinogenemia complicated by a complete placenta previa. The patient presented to labor and delivery triage with vaginal bleeding. This case report describes the management of this parturient and presents a review of the literature available for the anesthetic management of parturients with congenital hypofibrinogenemia. (A&A Practice. 2021;15:e01426.

Analgesia for a parturient is an important element of care provided by an anesthesiologist as a member of the multidisciplinary team. Neuraxial anesthesia is considered the gold standard. With increasing evidence of safety and efficacy of various available techniques and equipment, including ultra-short–acting opioids, local anesthetics, newer combined spinal–epidural needles, monitors, patient-controlled infusion pumps, and point-of-care ultrasound, obstetric care has become less challenging with higher patient satisfaction rates and better safety profiles. Recent articles spanning the last few years on important related topics, including care of the parturient during COVID, newer developments, enhanced recovery after cesarean (ERAC) protocols, and patients with unique profiles, are discussed in this update on obstetric analgesia.