Anesthetic Management Of Parturient Research Articles

Anaesthetic management of parturient with Wolff-Parkinson- White syndrome for emergency caesarean section under General Anaesthesia – A case report

Anaesthetic management of parturient with Wolff-Parkinson- White syndrome for emergency caesarean section under General Anaesthesia – A case report

Anesthetic management of parturients with achondroplasia: a case series

Background Achondroplasia is the most common form of dwarfism, and cesarean delivery is often required in parturients with achondroplasia due to cephalopelvic disproportion. Given the challenges for both regional and general anesthetic techniques, there is no consensus on the optimal anesthetic management for cesarean delivery in these patients. Method A search of our electronic medical records for all female patients who had a diagnosis of achondroplasia and had a delivery in our health system from January 1, 2001 through June 16, 2023 was performed. Institutional review board exemption was obtained. Results We identified seven achondroplastic patients with 12 cesarean deliveries and described their anesthetic management during labor and delivery. Conclusion Despite the historical preference of general anesthesia in achondroplastic patients due to concerns of unpredictable spinal anatomy and unreliable local anesthetic spread, neuraxial anesthesia was successfully utilized in achondroplastic parturients and is a viable option in carefully selected patients. Reduction of intrathecal local anesthetic dose that minimizes the risk of high spinal and emergent intubation, as well as a titratable neuraxial technique, can be effective in this patient population.

Anaesthetic Management of Parturient with Severe Mitral Stenosis Planned for Elective Caesarean Section for Safe Confinement

Perioperative management of pregnant women with cardiac disease is challenging. The physiological cardiac changes that occur during late pregnancy leads to haemodynamic stress to the patient with the cardiac disease during and immediately after parturition. Pregnant women with severe valvular disease do not tolerate haemodynamic changes associated with pregnancy. The choice of anaesthesia technique either general anaesthesia or regional anaesthesia is depending on the haemodynamic goals, cardiac status of the patient, and mode of delivery. A 23-year-old female patient was planned for elective caesarean section for safe confinement. She was an operated case of Balloon Mitral Valvuloplasty (BMV). General anaesthesia was preferred due to the severity of mitral stenosis. Incorporation of epidural analgesia with general anaesthesia provided intraoperatively haemodynamic stability during laryngoscopy, intubation, and extubation. Also, postoperatively analgesia could be achieved due to epidural top-ups. Ultimately, a good perioperative outcome has been achieved due to haemodynamic stability which reduces perioperative morbidity and mortality of the patient.

Anaesthetic Management of Parturient with Motor Neuron Disease for Caesarean Delivery: Case Report

Motor neuron disease (MND) is a progressive neurodegenerative disease of unknown aetiology, which results in weakness of muscles of phonation, ambulation, deglutition and respiration. It has low prevalence but high disability and fatality. Death often follows respiratory failure. There is no known cure. It is extremely rare in pregnancy, but when it occurs, the respiratory compromise worsens and anaesthesia becomes challenging. There is no consensus yet on the choice of anaesthesia. We present a 29-year-old, 32-week parturient with MND who presented with severe dyspnea, orthopnea and was diagnosed with severe respiratory distress. She was admitted into ICU and given anticoagulant and steroid therapy. Sequential mini-dose combined spinal-epidural anaesthesia (CSE) was given and surgery performed in the semi-sitting position successfully. There was no deterioration of symptoms post anaesthesia. We conclude that CSE is adequate to manage parturient with MND who has severe orthopnea following respiratory muscle paresis.

Anesthetic management of parturient with undiagnosed posterior reversible encephalopathy syndrome at term: A case report

Use of prompt and efficient anesthetic management of an actively convulsing gravid to term female in the OPD. In this case report, we present a successful anesthetic induction and management in a case of gravid to term female with active convulsions and complaints of vomiting and headache, later diagnosed as Posterior Reversible Encephalopathy Syndrome under General anesthesia.

COVID-19 and pregnancy: Challenges for an anesthesiologist

The anesthetic management of a pregnant patient with coronavirus disease 2019 (COVID-19) presents various unique challenges in terms of patient preparation, intraoperative management, and postoperative concerns, all while taking concurrent measures to prevent the spread of the virus from the patient to the healthcare workers. Anesthetic management of parturient in the era of the COVID-19 pandemic is further complicated by the fact that intubation and extubation are highly aerosol-generating procedures, and are generally advised to be avoided. While various organizations have come up with guidelines on the management of pregnant patients with COVID-19, definitive evidence-based guidelines for the same are lacking. This article aims to consolidate the available literature on the management of pregnant patients with COVID-19, with special impetus on the anesthetic management of these patients.

Pregnancy and COVID-19: what anesthesiologists should know.

Anesthetic management of parturients with COVID-19 is a big challenge to anesthesiologists. Limited data are available about COVID-19 during pregnancy; however, information on illnesses associated with SARS and MERS might provide insights into COVID-19's effects during pregnancy. Evidence from previous reports from SARS and MERS, and from COVID-19 cases were reviewed. Concepts from guidelines from the government and academic societies were collected as well. The evidence was described and summarized. Principles to minimize the risk of infection as well as optimize patients' safety during obstetric anesthesia were found to include careful evaluation, tight protection, and multi-discipline-based strategy. Though vertical transmission of COVID-19 still needs more definitive evidence, strict isolation is necessary for the newborn of COVID-19 mothers. Psychological support for the parturients is also an important issue during COVID-19 pandemic.

Anesthetic management of parturients with Arnold Chiari malformation-I: a multicenter retrospective study

BackgroundConsensus regarding the safest mode of delivery and anesthetic management for parturients with Arnold Chiari malformation-I (ACM-I) remains controversial. This study assessed their anesthetic management and reported anesthetic complications during hospitalization for delivery. MethodsThis was a multicenter, retrospective, cohort study of patients with ACM-I undergoing vaginal or cesarean delivery. Data were obtained from the electronic databases of four United States academic institutions using International Classification of Diseases (ICD) codes from 2007–2017 at three sites and 2004–2017 at one site. The primary outcome was anesthetic complications. ResultsData were analyzed for 185 deliveries in 148 patients. Diagnosis of ACM-I was made prior to delivery in 147 (80%) cases. Pre-delivery neurosurgical consultation for management of ACM-I was performed in 53 (36%) patients. Pre-existing symptoms were recorded for 89 (48%) of the deliveries. Vaginal deliveries occurred in 80 (43%) cases, and 62 women (78%) received neuraxial labor analgesia. Cesarean delivery was performed in 105 (57%) cases, of which 70 women (67%) had neuraxial anesthesia and 34 (32%) received general anesthesia. Post-dural puncture headache was reported in three (2%) patients who had neuraxial anesthesia, and in two (12%) patients with syringomyelia. There was one (3%) reported case of aspiration pneumonia with general anesthesia. ConclusionsThe findings suggest that anesthetic complications occur infrequently in patients with ACM-I regardless of the anesthetic management. Although institutional preference in anesthetic and obstetric care appears to drive patient management, the findings suggest that an individualized approach has favorable outcomes in this population.

Anesthetic Treatment of Cardiac Disease During Pregnancy

This review summarizes the pathophysiology, peripartum treatment, and anesthetic management of parturients with cardiac disease. Valvular disease, coronary disease, and cardiomyopathy are specifically addressed in the context of the normal physiologic changes of pregnancy. We offer recommendations for anesthetic approaches, hemodynamic goals with an emphasis on interdisciplinary planning between anesthesiologists, cardiologists, cardiothoracic surgeons, obstetricians, maternal fetal medicine specialists, and neonatologists. Vaginal delivery with neuraxial analgesia can be well tolerated by many pregnant patients with cardiac disease when coordinated by an interdisciplinary team of experts. Cardiac disease in pregnancy can present a significant challenge for the interdisciplinary care team. A detailed understanding of each patient's cardiac pathology and the physiologic changes of pregnancy are critical to ensure a safe and successful labor and delivery. Optimized medical therapy in the peripartum period and neuraxial anesthesia with the judicious use of vasoactive agents can be of great benefit for these parturients. As is generally the case, cesarean delivery should be primarily reserved for obstetric indications and maternal wellbeing, with careful consideration of the fetus to guide best practices.

Anesthetic management of parturient with hyperhomocysteinemia for cesarean section

Hyperhomocysteinemia is due to genetic and acquired changes in the metabolism of homocysteine. It is associated with an increased risk for vascular occlusive disease and thrombosis. Because methylene tetrahydrofolate reductase abnormality is a genetic disorder and hyperhomocysteinemia along with pregnancy in women further aggravates the risk of thrombosis; therefore, these patients undergo antepartum anticoagulant treatment with low molecular weight heparin. These patients pose a unique challenge to anesthetist, when it comes to choosing a type of anesthesia. Neuraxial anesthesia techniques may be relatively contraindicated in anticoagulated patients and nitrous oxide may exacerbate the condition, by inhibiting the conversion of homocysteine to methionine. In this study, we intend to discuss the anesthetic implications and management of a pregnant patient with hyperhomocysteinemia undergoing cesarean section.

Severe aortic stenosis in a parturient with twins: The challenges

Aortic stenosis (AS) in young women is often the result of a congenital bicuspid aortic valve, occurring in 1–2% of the population. Although the anaesthetic management of parturients with AS remains controversial, the high rate of caesarean delivery is consistent among studies. A 30-year-old primi gravida with severe AS presented for elective caesarean section at 36 weeks gestation (twins). She had a failed balloon valvuloplasty 15 years ago and declined further intervention. Prior to induction, invasive lines and prophylactic extracorporeal membrane oxygenation cannulas were placed. A modified rapid sequence intubation technique with propofol/remifentanil target-controlled infusion and suxamethonium was performed. Anaesthesia was maintained using total intravenous anaesthesia. Both twins were delivered uneventfully and oxytocin infusion was commenced. Gradual desaturation to 95% occurred intraoperatively and a focused lung ultrasound and transthoracic echocardiogram were performed. Intravenous frusemide 20 mg was administered empirically. Post-operatively, the patient was extubated and transferred to the Intensive Care Unit for monitoring.Severe AS is associated with high risk of maternal morbidity and mortality. In our case, due to the twin gestation, cardiac output and metabolic demands rise exponentially leading to increased risks. A multidisciplinary approach with appropriate monitoring and point-of-care testing are key to such complex cases to achieve favourable maternal and foetal outcomes.

Anaesthetic Management of Parturients With Univentricular Congenital Heart Disease and the Fontan Operation

(Int J Obstet Anesth. 2016;28:83–91) Over the past few decades, as surgical treatment of congenital heart disease (CHD) has improved, an increasing number of women with CHD are becoming pregnant and obstetric anesthesiologists must be able to manage these women during labor and delivery. One of the newest challenges is that presented by women with a single ventricular circulation that has been palliated with the Fontan operation.

Anesthetic Management for Cesarean Delivery in Parturients With a Diagnosis of Dwarfism

(Can J Anaesth. 2016;63(8):945–951) An adult height of 148 cm or less is defined as dwarfism. Advances in reproductive technologies have enabled women with dwarfism to conceive and bear children. It is known that pregnant women with either proportionate or disproportionate dwarfism have a greater risk of cesarean delivery compared with those without dwarfism. The anesthetic management of parturients with dwarfism is challenging owing to the large anatomical variations and heterogeneity among patients with dwarfism. The present study was a retrospective report on the anesthetic management of 13 parturients who were diagnosed with dwarfism and underwent cesarean deliveries.

Anaesthetic management of parturient with malaria and thrombocytopaenia.

Malarial infection during pregnancy is a significant public health problem with substantial risk for the pregnant woman and newborn child. Globally, 125 million women are at risk every year. In Sub-Saharan Africa, 23 million pregnant women are exposed to malarial infection annually and approximately 400,000 pregnant women develop moderate to severe anaemia.[1] We report successful perioperative management of case of Plasmodium vivax infection in full-term parturient who presented with thrombocytopaenia and deep transverse arrest and subsequently developed right occipito-parietal haematoma with mass effect.

Anesthetic management of parturients with cerebral palsy and polymyositis coming for cesarean section: Two case reports

Anesthetic management of parturients with cerebral palsy and polymyositis coming for cesarean section: Two case reports

Peripartum Outcomes and Anaesthetic Management of Parturients With Moderate to Complex Congenital Heart Disease or Pulmonary Hypertension

We performed a retrospective cohort analysis of pregnancies among women with moderate to complex congenital heart disease or pulmonary hypertension over a 12-year period, resulting in a cohort of 107 cases in 65 women. Neuraxial analgesia or anaesthesia was provided in 84%, 89% and 95% of spontaneous vaginal, operative vaginal and caesarean deliveries, respectively. The caesarean delivery rate was 43% compared to our institution average of 27% over the same period (p = 0.02), and 38% had operative vaginal deliveries compared to a 10.5% institution rate (p < 0.01). Invasive monitoring was used in 28% of all deliveries. There were one maternal and two neonatal deaths. This study provides detailed anaesthetic and peripartum management of women with congenital heart disease, a patient population in whom evidence-based practice and data are largely lacking. We observed a predominance of neuraxial anaesthetic techniques, increased caesarean and operative delivery rates, and favourable maternal and neonatal outcomes. Multicentre studies and registries to compare anaesthetic and obstetric management strategies further and delineate risk factors for adverse outcomes are required.

Anesthetic management of parturient with thoracic kyphoscoliosis, malaria and acute respiratory distress syndrome for urgent cesarean section

The management of cesarean section in kyphoscoliotic patient is challenging. The respiratory changes and increased metabolic demands due to pregnancy may compromise the limited respiratory reserves in such patients. Presence of other comorbidities like malaria and respiratory tract infection will further compromise the effective oxygenation. We report a case of kyphoscoliosis along with malaria and acute respiratory distress syndrome for urgent cesarean section.

Peripartum Outcomes and Anesthetic Management of Parturients With Moderate to Complex Congenital Heart Disease or Pulmonary Hypertension

Peripartum Outcomes and Anesthetic Management of Parturients With Moderate to Complex Congenital Heart Disease or Pulmonary Hypertension

Anaesthetic Management of Parturient with Acute Atrial Fibrillation for Emergency Caesarean Section

A 31-year-antenatal lady with critical mitral stenosis presented for emergency caesarean section with fetal distress. She had acute onset atrial fibrillation. She was given a combined spinal epidural (CSE) anaesthesia and her arrhythmia was successfully managed after delivery of the baby with intravenous calcium channel blocker. Mitral stenosis is the most common valvular heart disease complicating pregnancy in developing countries. The physiological changes during pregnancy may exacerbate their cardiac symptoms. They may present with complications like congestive cardiac failure, atrial fibrillation, or pulmonary thromboembolism during the antenatal, intrapartum, or postpartum period. Here we discuss the management of parturient woman with high maternal and fetal risk presenting for emergency caesarean. The merits of regional anaesthesia and the importance of invasive monitoring are also discussed.

Peripartum outcomes and anaesthetic management of parturients with moderate to complex congenital heart disease or pulmonary hypertension*

We performed a retrospective cohort analysis of pregnancies among women with moderate to complex congenital heart disease or pulmonary hypertension over a 12-year period, resulting in a cohort of 107 cases in 65 women. Neuraxial analgesia or anaesthesia was provided in 84%, 89% and 95% of spontaneous vaginal, operative vaginal and caesarean deliveries, respectively. The caesarean delivery rate was 43% compared to our institution average of 27% over the same period (p=0.02), and 38% had operative vaginal deliveries compared to a 10.5% institution rate (p<0.01). Invasive monitoring was used in 28% of all deliveries. There were one maternal and two neonatal deaths. This study provides detailed anaesthetic and peripartum management of women with congenital heart disease, a patient population in whom evidence-based practice and data are largely lacking. We observed a predominance of neuraxial anaesthetic techniques, increased caesarean and operative delivery rates, and favourable maternal and neonatal outcomes. Multicentre studies and registries to compare anaesthetic and obstetric management strategies further and delineate risk factors for adverse outcomes are required.