Thoracic spinal anesthesia for cesarean section in severe pre-eclampsia: exploring a new dimension

Rajeev Chauhan,Shyamcharan Meena,Rashi Sarna,Pranshuta Sabharwal

doi:10.1186/s42077-021-00143-9

Abstract

BackgroundSevere pre-eclampsia poses a dilemma for the anesthesiologist especially in emergency situations where cesarean deliveries are done for the un-investigated or partially investigated parturient. Hemodynamic stability is the major goal of anesthetic management of these patients. Thoracic spinal anesthesia has been successfully given for various surgeries like breast cancer and abdominal cancer but not for cesarean section.Case presentationWe report a case of a 35-year-old at 33+5-week period of gestation with severe pre-eclampsia and bullous lesions managed successfully with segmental thoracic spinal anesthesia. General anesthesia in this patient could have been risky as the patient was not fasting; airway bullous lesions could not be ruled out and Mallampati grade was III on airway examination. Presence of lesions in lumbar region precluded the lumbar spinal technique. The technique was associated with an adequate level of the sensory block during lower segment cesarean section, a high degree of hemodynamic stability, and a high patient satisfactionConclusionSegmental thoracic spinal anesthesia can be used successfully and effectively for lower segment cesarean section by experienced anesthetists. Further studies are warranted to compare its effect, especially on hemodynamics with known techniques.

Highlights

Severe pre-eclampsia poses a dilemma for the anesthesiologist especially in emergency situations where cesarean deliveries are done for the un-investigated or partially investigated parturient
We report an unbooked case of severe pre-eclampsia with a bullous lesion of pemphigus foliaceus in the lumbar region managed successfully with thoracic spinal
Case presentation A 35-year-old with BMI 33 kg/m2 at 33+ 5-week period of gestation with a history of severe preeclampsia presented for emergency lower segment cesarean section (LSCS) in view of reversal of end-diastolic flow (REDF) in uterine artery

Summary

Background

The best anesthetic technique for cesarean delivery in such cases is regional anesthesia. At pre-anesthetic assessment, we came to know that the patient had taken solid food 4 h earlier, and her non-invasive blood pressure (NIBP) readings during the last few hours of admission in the records were in the range of 180–210/110–20 mmHg, and on airway assessment, she was Mallampati grade III. She had crusted lesions on her back in the lumbar. In the post-operative period, hemodynamics (Fig. 1) were monitored and the patient was followed up for any neurologic deficit or any other complaint till the date of discharge from the hospital, and none was reported

Findings

Discussion

Conclusion