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Posters • Obstetrics 147

95. Local anaesthetic allergy testing inregnancy

. Govindarajan, M. Shields, S. Atkinsonoyal Jubilee Maternity Hospital, Department ofnaesthesia, Belfast, UK

ackground: Local anaesthetic (LA) testing during pregnancyarries the risk of inducing an anaphylactic reaction which may beife threatening for the mother and foetus. However the risk has toe weighed against the safety of regional anaesthesia compared toeneral anaesthesia for the pregnant patient. We report the suc-essful management of a pregnant woman with a history of sus-ected LA allergy.

ase Report: A 32-year-old, para 2 female was referred at 34eeks gestation with a history of severe allergic reaction to LA in

hildhood. There had been no follow up testing on this occasion.he had had two previous uneventful vaginal deliveries withoutegional analgesia. On examination she was Mallampatti grade III,hort necked and had a BMI of 34. At 39 weeks gestation intrader-al skin testing was performed. Intradermal skin testing was per-

ormed at 39 weeks gestation, with an obstetric team on standby,hould caesarean section be required. Levobupivacaine 0.02ml of:10000 was injected. No weal or flare was observed after 15inutes and so intradermal injections were repeated with 10 fold

ncreases in drug concentration till neat drug was given. Followinghich 1 ml of 0.25% Levobupivacaine was injected. A negative

esponse was obtained for every injection.Labour was induced aterm and the lady delivered vaginally without systemic analgesia.ost delivery, she had an uneventful surgical repair of a thirdegree perineal tear under spinal anaesthesia using Levobupiva-aine 10mg.

iscussion: Published case reports1,2 suggest that the optimal timeor testing is close to term with an obstetric team on standby. Basedn a negative response to intradermal testing to Levobupivacaineear term, it was possible to avoid general anaesthesia in a patientith a anticipated difficult airway.

eference) Anesthesia & Analgesia 2003; 96:1489-90.) International Journal of Obstetric Anaesthesia 2003; 12 113-115.

28. Combined spinal- epiduralnesthesia for cesarean section in a patientith dilated cardiomyopathy

. Arora, A. Kulshresthaostgraduate Institute of Medical Education andesearch, Department of Anaesthesia and Intensive Care,handigarh, India

ackground and Aim: The incidence of idiopathic dilated cardio-yopathy in pregnant patients is 5-8/100000 live births per year.

his has poorer outcome as compared to peripartum cardiomyop-thy. The aim of this presentation is to report a case of Adriamycinnduced dilated cardiomyopathy associated with left lung collapsend deranged renal function presenting for elective cesarean sec-ion.

ase Report: A 24 years old primigravida at 32 weeks of gestationame to hospital for safe confinement in view of her worseningeart disease. She had history of right upper limb amputation andhemotherapy with Adriamycin for Ewing’s sarcoma of ulna sixears ago. Following chemotherapy, she developed dyspnoea onxertion (NYHA class III) and was diagnosed to have dilated car-iomyopathy. Her condition improved with T. Digoxin 0.25 mg.D and T. Lasix 20 mg B.D. As the pregnancy advanced her cardiac

ymptoms worsened (NYHA class III). On examination there waseft lung collapse, deranged renal functions and one episode ofaroxysmal ventricular tachycardia two days ago, which had re-olved by carotid massage. Her present echocardiography findingsere ejection fraction of 30%, left ventricular systolic dysfunction

nd mild pericardial effusion. A combined spinal epidural anesthe-ia was planned. Only 25 ug of Fentanyl was given in the L3-4ubarachnoid space while epidural blockade was established in araded fashion with the help of 2% Lidocaine. The patient�s he-odynamic status was monitored with direct intra-arterial blood

ressure and central venous pressure measurements. The patientemained hemodynamically stable throughout the procedure andelivered a healthy baby (APGAR 9/10).

onclusion: An incremental combined spinal-epidural anestheticechnique with invasive monitoringmay be an acceptable anes-hetic alternative in patients suffering from dilated cardiomyopa-hy, undergoing Cesarean section.