TITLE:
Anesthetic Dilemma: Spinal Anesthesia in a Severe Pre-Eclamptic Patient with Twin Gestation, Heart Failure and Acute Pulmonary Edema
AUTHORS:
E. O. Oyebamiji, B. B. Osinaike, B. T. Olaifa, A. A. Adeniji
KEYWORDS:
Severe Preeclampsia, Pulmonary Edema, Anesthetic Management, Poor Resource Setting
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.5 No.4,
April
13,
2015
ABSTRACT:
Background: Severe preeclampsia with acute pulmonary oedema possesses
great challenges to the anaesthetist. If not well managed, it could be
associated with high maternal morbidity and mortality rate as well as fetal
wastage. Aim: To sensitize the anaesthetist that when confronted with such a
dilemma, well managed low spinal block can be a useful and successful
anaesthetic technique. Methods: We report the case of a 23-year-old
primigravida with twins gestation at 36 weeks, who presented with severe
ante-partum pre-eclapsia, acute pulmonary oedema and acute heart failure. Blood
investigations done were normal, and clotting time was within normal range. Her
clinical conditions were optimized through a well thoughtful medication after
which a low dose spinal anesthesia was performed using 1.5 mls (7.5 mg) of 0.5%
hyperbaric bupivacaine (Modified saddle). The baby was delivered through a low
segment caesarean section. Conclusion: The procedure was well tolerated and
successful. Low spinal is associated with low incidence of hypotension and do
not require pre-loading.