Anesthetic Dilemma: Spinal Anesthesia in a Severe Pre-Eclamptic Patient with Twin Gestation, Heart Failure and Acute Pulmonary Edema

E O Oyebamiji,B B Osinaike,B T Olaifa,A A Adeniji

doi:10.4236/ojog.2015.54030

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.

Highlights

Pregnancy-induced hypertension (PIH) and preeclampsia are the most common medical complications of preg-How to cite this paper: Oyebamiji, E.O., Osinaike, B.B., Olaifa, B.T. and Adeniji, A.A. (2015) Anesthetic Dilemma: Spinal Anesthesia in a Severe Pre-Eclamptic Patient with Twin Gestation, Heart Failure and Acute Pulmonary Edema
Preeclampsia is more important than hypertension alone because of the associated alterations in cardiovascular, renal, coagulation, hepatic function and central nervous system as well as poor fetal outcome
We present a typical case of severe pre-eclampsia with acute pulmonary edema, and cardiac failure managed in our centre

Summary

Introduction

Pregnancy-induced hypertension (PIH) and preeclampsia are the most common medical complications of preg-How to cite this paper: Oyebamiji, E.O., Osinaike, B.B., Olaifa, B.T. and Adeniji, A.A. (2015) Anesthetic Dilemma: Spinal Anesthesia in a Severe Pre-Eclamptic Patient with Twin Gestation, Heart Failure and Acute Pulmonary Edema. (2015) Anesthetic Dilemma: Spinal Anesthesia in a Severe Pre-Eclamptic Patient with Twin Gestation, Heart Failure and Acute Pulmonary Edema. Perinatal mortality occurs in 20% - 30% of affected mothers [1] It is a pregnancy induced disorder with complex etiology. The choice of anaesthesia for caesarean section in patient with severe pre-eclampsia remains controversial [2]. 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. 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). Low spinal is associated with low incidence of hypotension and do not require pre-loading

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