scholarly journals Alternative to General Anesthesia for a Stat Cesarean Delivery in a Patient with a Large Arteriovenous Malformation Involving the Cervicomedullary Junction in Active Labor

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Christiano dos Santos e Santos ◽  
David A. Joyner ◽  
Cristiane A. Tuma Santos ◽  
Bernadette E. Grayson ◽  
Arthur Calimaran ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Cesarean Delivery ◽  
Anesthetic Management ◽  
Past Medical History ◽  
Spontaneous Vaginal Delivery ◽  
Emergency Cesarean ◽  
Active Labor ◽  
Spinal Epidural ◽  
Neurologically Intact ◽  
Cardiovascular Stability

A 20-year-old G1P0 patient at 38 weeks and 1 day of gestation was admitted for emergency cesarean delivery. Her past medical history was positive for cervicomedullary arteriovenous malformation (AVM) that ruptured three years before. Spontaneous vaginal delivery was contraindicated by neurosurgery. Aiming for cardiovascular stability and immediate reduction of sympathetic activity, a combined spinal epidural was successfully placed. An uneventful cesarean section was performed. The patient was transferred to the intensive care unit neurologically intact and discharged home after 8 days. This report describes an unusual anesthetic management of a patient with a large AVM in active labor.

A Randomized Study of Combined Spinal-Epidural Analgesia versus Intravenous Meperidine during Labor 

1998 ◽  
Vol 89 (6) ◽  
pp. 1336-1344 ◽  
Author(s):  
David R. Gambling ◽  
Shiv K. Sharma ◽  
Susan M. Ramin ◽  
Michael J. Lucas ◽  
Kenneth J. Leveno ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Cesarean Delivery ◽  
Local Anesthetics ◽  
Full Term ◽  
Operative Delivery ◽  
Fetal Bradycardia ◽  
Combined Spinal Epidural ◽  
Nulliparous Women ◽  
Emergency Cesarean ◽  
Spinal Epidural

Background Combined spinal-epidural (CSE) analgesia produces rapid-onset pain relief and allows ambulation in early labor. Epidural local anesthetics may contribute to an increase in operative deliveries by decreasing perineal sensation and causing motor weakness. Operative delivery rates might be reduced with CSE, by avoiding or delaying administration of local anesthetics. This study compares the operative delivery rates associated with a CSE technique and those associated with intravenous meperidine for labor analgesia. Methods Healthy parturients at full term were assigned randomly to receive CSE or intravenous meperidine analgesia. The CSE group received 10 microg intrathecal sufentanil, followed by epidural bupivacaine and fentanyl at their next request for analgesia. Parturients receiving intravenous meperidine had 50 mg on demand (maximum, 200 mg in 4 h). Labor and delivery outcomes in both groups were recorded and compared. Results An intent-to-treat analysis of 1,223 women indicated that CSE does not increase the rate of cesarean delivery for dystocia in nulliparous and parous women (CSE, 3.5% vs. intravenous meperidine, 4; P=not significant) or in nulliparous women alone (CSE, 7% vs. intravenous meperidine, 8%; P=not significant). Profound fetal bradycardia that necessitated emergency cesarean delivery within 1 h of the time the mother received sufentanil occurred in 8 of 400 parturients (compared with 0 of 352 who received meperidine; P < 0.01). However, the method of fetal monitoring differed between the two groups. Despite this, neonatal outcomes were similar overall. Conclusions Combined spinal-epidural analgesia during labor does not increase the cesarean delivery rate for dystocia in healthy parturient patients at full term, regardless of parity. However, an unexpected increase in the number of cesarean deliveries for profound fetal bradycardia after intrathecal sufentanil was observed. Further investigation is warranted.

scholarly journals Perioperative anesthetic management for cesarean delivery of severe Wilson’s disease with liver failure: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Kana Saito ◽  
Eiko Onishi ◽  
Jun Itagaki ◽  
Noriko Toda ◽  
Azusa Haitani ◽  
...  
Keyword(s):  
Liver Failure ◽  
Cesarean Delivery ◽  
Wilson’S Disease ◽  
Body Weight Gain ◽  
Anesthetic Management ◽  
Copper Metabolism ◽  
Autosomal Recessive Disorder ◽  
Wilson's Disease ◽  
Copper Accumulation ◽  
Emergency Cesarean

Abstract Background Wilson’s disease is a rare autosomal recessive disorder affecting copper metabolism, which presents liver and brain dysfunction caused by abnormal copper accumulation. We report a patient who showed exacerbation of liver failure during pregnancy. Case presentation A 24-year-old woman with Wilson’s disease was scheduled for emergency cesarean delivery at 30 weeks of gestation. The patient exhibited severe coagulopathy and prominent body weight gain (+ 30 kg) caused by systemic edema and ascites. We decided to perform emergency cesarean delivery under general anesthesia. We used platelet concentrates, cryoprecipitate, and fibrinogen concentrate. Intraoperative hemorrhage was well controlled. On the 15th postpartum day, weight was reduced by 20 kg and liver function had improved. She and her baby were discharged without complications. Conclusions The appropriate continued treatment of Wilson’s disease and supplementation of coagulation factors and/or platelets when indicated greatly increase the likelihood of a successful pregnancy, even in patients with liver failure exacerbation.

Prediction of Post spinal anesthesia hypotension in patients undergoing cesarean section using Perfusion index

2020 ◽  
Vol 5 (3) ◽  
pp. 1241-1245
Author(s):  
Kumud Pyakurel ◽  
Lalit Kumar Rajbanshi ◽  
Ramesh Bhattarai ◽  
Sonia Dahal
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Supine Position ◽  
Roc Curve ◽  
Anesthetic Management ◽  
College Teaching ◽  
Perfusion Index ◽  
Sensory Level ◽  
Roc Curve Analysis ◽  
Group I

Introduction: Spinal anesthesia induced hypotension frequently complicates Cesarean delivery. This is usually due to sudden sympatholysis causing decreased venous return which can be aggravated by physiological changes of pregnancy leading to change in baseline peripheral vascular tone. Strategies to prevent hypotensive episodes should be the primary aim of anesthetic management. A simple noninvasive measurement of perfusion index derived from pulse oximeter predicting hypotension during the routine intraoperative course could provide a new dynamism to the management and improving the safe execution of anesthesia. Objectives: The primary objective of this study was to compare incidence of hypotension following SAB for LSCS in patients with baseline PI ≤ 3.5 to those with PI > 3.5. The secondary objectives were to compare PI, HR, SBP, MAP at various time intervals and also to study the side effects between the two groups. Methodology: This prospective observational study was conducted at Nobel Medical College Teaching Hospital from to July 2019 to October 2019. 73 Term parturients presenting for elective cesarean delivery were included for the study. Upon arrival in the operation room, standard monitors were attached and baseline HR, SBP, DBP, MAP, PI and SPO2 were recorded in supine position. The patients with baseline PI ≤ 3.5 were enrolled into Group I and those with a PI > 3.5 were enrolled into Group II. Spinal Anesthesia with 10mg of 0.5% heavy Bupivacaine and 20mcg Fentanyl ( total 2.4ml) was given at L3-L4 interspace in sitting position using midline approach. Patient was then returned to supine position with left lateral tilt of 15 degrees to facilitate left uterine displacement. Upper sensory level was checked at 5 minutes using alcohol swab. Once T-6 level was reached, surgery was started. Maternal SBP, DBP, MAP, HR and PI were recorded at 1 minute intervals between spinal injection and delivery and then 3 minutes until end of surgery. Clinically relevant hypotension was defined as the decrease in MAP by 20% or more from baseline value. Results: The incidence of hypotension in Group I was 18.8% (6/30) compared to 81.3% (26/38). This was clinically and statistically highly significant (P = 0.000, odds ratio 0.11). On Spearman’s rank correlation we found highly significant correlation between baseline PI >3.5 and number of episodes of hypotension (rs 0.482, P = 0.000). The sensitivity and specificity of baseline PI with cut-off 3.5 for predicting hypotension were 81.3% and 66.7% respectively. The ROC curve analysis showed 3.53 as appropriate cut‑off for our findings. The area under the ROC curve (AUC) was 0.734 [Figure 6](Lower bound 0.608 and upper bound 0.861, P=0.001).  Conclusion : This study demonstrates that baseline PI of > 3.5 correlates with incidence of hypotension after spinal anesthesia for cesarean delivery in healthy parturients compared to a baseline PI of < 3.5.

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