Anesthetic Management For Cesarean Section Research Articles

Anesthetic management for cesarean section in two parturient with ascending aortic aneurysm: a case-based discussion

BackgroundThe anesthetic management of parturients with ascending aortic aneurysm for cesarean section can be particularly challenging, primarily because of increased risk for aortic dissection or aneurysm rupture.Case presentationWe present some aspects of the anesthetic management of two parturients with ascending aortic aneurysm for cesarean sections; amongst, the use of remifentanil with its effects on patient and newborn. We emphasize the importance of a cardio-obstetric team in the context of preoperative planning of such patients. Also, we reviewed some literature on the anesthetic management with its effect on peri-operative hemodynamic stability.ConclusionMaintaining hemodynamic stability is paramount in the prevention of the rupture or dissection of ascending aortic aneurysm during labor of parturient.

Caesarean section under spinal anesthesia for a mother with dilated cardiomyopathy in a resource-limited setting: a case report

Introduction and importance: Peripartum cardiomyopathy is an uncommon form of cardiomyopathy that develops in the latter stages of pregnancy or in the first few weeks following delivery. Anaesthetic management of caesarean section of a parturient with dilated cardiomyopathy is challenging due to its nature of impaired ventricular contractility coupled with cardiovascular changes during pregnancy. This is significantly worse in a resource-constrained environment with restricted access to medications and equipment. Case presentation: We report a case of a 31-year-old multigravida parturient presented with a diagnosis of dilated cardiomyopathy and a low ejection fraction undergoing emergency caesarean section. Successful management of a parturient with dilated cardiomyopathy undergoing a caesarean section under spinal anaesthesia is reported in this case report. Clinical discussion: Spinal anaesthesia is another alternative for the successful management of patients with dilated cardiomyopathy (DCM) using a low dose of bupivacaine with intrathecal adjuvants. Our report indicates that caesarean section also may be managed safely with spinal anaesthesia alone in patients with DCM, by using low-dose bupivacaine and intrathecal morphine. The slight haemodynamic changes were adjusted with fluid infusion. The use of vasopressors was not required to manage the hypotension. Conclusion: General anaesthesia, epidural alone, and epidural combined with spinal anaesthesia are the widely used anaesthetics techniques for caesarean section in patients with heart disease. Spinal anaesthesia with low-dose bupivacaine with opioids is another suitable choice. The case report is written according to the CARE guideline (https://www.care-statement.org).

Anesthetic Management for Cesarean Section in a Patient with Achondroplasia: Case Report and an Updated Review

Achondroplasia is a rare genetic disorder and the leading cause of dwarfism worldwide. Patients with achondroplasia often present with spinal abnormalities, respiratory and cardiac disorders, obstructive sleep apnea, and facial deformities. Cesarean section is commonly required due to cephalopelvic disproportion in these patients. However, the choice of anesthetic technique for cesarean sections in this population is controversial and should be based on a careful assessment of the risks and benefits of each approach. In this article, we present a case of a 39-year-old primiparous woman with achondroplasia who underwent a cesarean section under titrated epidural anesthesia. We also discuss other anesthetic techniques described in the literature, highlighting their advantages and limitations.

Anaesthetic Management of Caesarean Section in Asymptomatic COVID-19 Positive Parturients with Abnormal Laboratory Findings: A Series of 15 Cases

During the Coronavirus Disease 2019 (COVID-19) pandemic, Caesarean Sections (CS) were prioritised over other elective surgeries, leading to the identification and management of asymptomatic COVID-19 positive parturients. The present case series aimed to explore the possibility of laboratory abnormalities and adverse events that can occur in asymptomatic COVID-19 positive cases in the post-pandemic era when routine screening is no longer in place. Out of 141 asymptomatic COVID-19 positive CS patients, 15 cases were selected based on specific criteria. Demographic characteristics and clinical indicators were analysed, including age, gravidity, indications for CS, laboratory values {such as D-dimer, C Reactive Protein (CRP), and platelet count}, blood transfusion requirements, and obstetric outcomes. Indications for CS were predominantly previous CS and failure to progress. Laboratory abnormalities included elevated D-dimer, CRP, leukocyte count, and thrombocytopenia in some cases. Haemodynamic stability was maintained in all patients. The use of prophylactic anticoagulation was noted, potentially offering protection against thrombosis. Asymptomatic COVID-19 positive parturients can exhibit significant laboratory abnormalities. Thromboprophylaxis may play a role in mitigating thrombotic risks. The significance of the present case series lies in the fact that the laboratory abnormalities could only be detected since all positive patients were investigated as per hospital protocol, which will be missed in the post-COVID-19 era where routine investigations are not performed on asymptomatic patients. Therefore, healthcare workers should be aware of this possibility

Anesthetic management of cesarean section in a patient with Léri-Weill dyschondrosteosis – A case report

Anesthetic management of cesarean section in a patient with Léri-Weill dyschondrosteosis – A case report

Fine-tuning anesthesia for cesarean section in an operated case of Tetralogy of Fallot

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Pregnancy in patients with congenital cyanotic heart disease (corrected and uncorrected ) presents with challenges to anesthesiologist.We report the anesthetic management for cesarean section in a patient of corrected case of TOF.Patient with Fallot’s tetralogywith significant RVOTO infundibulurvalvular, L-R shunt underwent intracardiac repair withsubannular patch at the age of 3 years.

Anesthetic Management of Cesarean Section for A Covid-19 Positive Patient: Case Report

Anesthetic Management of Cesarean Section for A Covid-19 Positive Patient: Case Report

Anesthetic management of cesarean section in a patient with Takayasu\u2019s arteritis: a case report

BackgroundTakayasu’s arteritis (TA) is a chronic, progressive, inflammatory arteritis. We presented the case of cesarean section in a patient with TA.Case presentationA 31-year-old pregnant woman with TA underwent a planned cesarean section at 34 weeks of pregnancy. She had stenosis of the cerebral and coronary arteries and heart failure due to aortic regurgitation. Spinal anesthesia was performed. In addition to standard monitoring, arterial blood pressure in the dorsalis pedis artery and regional cerebral tissue oxygen saturation were monitored. Intraoperative arterial blood pressure was maintained using continuous infusion of noradrenaline with a careful intermittent bolus infusion of phenylephrine. All the procedures were successfully performed without significant complications.ConclusionsIn a pregnant woman with TA, severe stenosis of the cerebral and coronary arteries, and heart failure due to valvular heart disease, careful anesthetic management by selecting catecholamines and assessing the perfusion pressure for critical organs is important.

Anaesthetic management for caesarean section in a patient with Sjogren's syndrome.

Anaesthetic management for caesarean section in a patient with Sjogren's syndrome.

Anesthetic management of a parturient with Wernicke's encephalopathy secondary to hyperemesis gravidarum for cesarean section

Wernicke's encephalopathy (WE) secondary to hyperemesis gravidarum (HG) is a rare but a known complication. A delay in diagnosis and treatment often results in long-term neurological sequelae. Critical care management of these patients is reported in the literature, but their anesthetic management for cesarean section is lacking. We report the case of a 28-year-old parturient who presented with HG in the first trimester of pregnancy and was managed conservatively. She later developed nystagmus, weakness, and cognitive dysfunction, and a diagnosis of WE secondary to HG was established. The patient was later posted for cesarean section in view of persistent quadriparesis and cognitive impairment at term gestation. General anesthesia was the preferred anesthesia technique of choice. Obstetric patients with preexisting neurological disease for cesarean section become a special subpopulation for anesthesiologists with their unique anesthetic challenges.

Anaesthetic management of caesarean section in a patient with Pompe disease.

Anaesthetic management of caesarean section in a patient with Pompe disease.

Elaborate anesthetic management of cesarean section followed by abdominal radical hysterectomy for uterine cervical cancer: case report

Cervical cancer is occasionally detected in pregnant women. If the patient desires the pregnancy, surgical treatment is recommended for cervical cancer at stage IA2 or IB1 when the fetus is mature enough to be delivered. A combination of spinal and epidural anesthesia for cesarean section, followed by general intravenous anesthesia for abdominal radical hysterectomy, was conducted in this case. Two catheters were placed in the upper extremity before anesthesia using ultrasound guidance for invasive arterial pressure monitoring and central venous access. General anesthesia was administered for the abdominal radical hysterectomy under propofol and remifentanil target-controlled infusion to maintain bispectral index at 40–50. Postoperative analgesia was administered via the epidural catheter. The neonate (2475 g) was delivered in 6 minutes, and the Apgar score was 10-10-10 at 1, 5, and 10 minutes. After the surgery, which took 4 h 18 min in total, the patient awakened from anesthesia and was extubated without complications.

Anesthetic management of cesarean section of a wheelchair bound parturient with myelomeningocele

Neural tube defects (NTD) affect 1-2 in 1000 pregnancies over the world. The most frequent spinal dysraphisms are meningocele and myelomeningocele while the spina bifida occulta, tethered cord, lipomyelomeningocele, split cord malformations, neuroenteric cyst, and several other conditions occur less frequently. Open spinal dysraphisms (meningocele and myelomeningocele) are compatible with postnatal survival, but they can result in severe neurologic impairment as inability to ambulate, urinary incontinence, hydrocephalus, scoliosis, and gastrointestinal (GI) disorders. Closed spinal dysraphisms (spina bifida occulta, tethered cord, lipomyelomeningocele, split cord malformations, neuroenteric cyst) are often less severe and sometimes asymptomatic but may result in severe neurologic impairment secondary to spinal cord tethering. Modern health care facilities has resulted in a significant decrease in the mortality rate in patients with SB2 along with improved survival rate up to 80%. Due to the neurologic complexity and severity of these conditions, it is paramount to understand the challenges and offer the best anesthetic approach for these patients. To the best of our knowledge, this is the first case of SB going under caesarean delivery in our hospital. We wish to highlight our experience of perioperative management of this patient.
 Key words: Spina bifida, anesthetic management
 Citation: Lal S, Aisa T, Akram U, Sher A, Memon Z, Moriarty RM. Anesthetic management of cesarean section of a wheelchair bound parturient with myelomeningocele. Anaesth. pain intensive care 2020;24(5):
 Received: 13 June 2020, Reviewed: 24 June 2020, Revised: 18 July 2020, Accepted: 8 August 2020

Anesthetic management for emergency cesarean delivery in parturient with achondroplasia – A case report and review of the literature

Achondroplasia is a genetic disorder where there is underdevelopment and shortening of the long bones formed by endochondral ossification without abnormalities of cartilage formation. Patients with achondroplasia can exhibit various manifestations: spinal abnormalities; thorao-lumbar kyphoscoliosis, respiratory and cardiac abnormalities; obstructive sleep apnea; and changes of the head and the midface. In women with achondroplasia, cesarean delivery is inevitable because the pelvis is invariably small. Anesthetic management for cesarean section in this population is controversial; the choice of anesthetic technique depends on the benefits and risks of each technique. Emergency cesarean is another factor to consider for the choice of anesthetic technique. We report the case of a 34-year-old Moroccan primipara with achondroplasia who had a cesarean delivery under Spinal anesthesia. Other possible anaesthetic techniques used for cesarean sections in such patients are also discussed.

Preeclampsia. Eclampsia. Anesthesia and intensive care in childbirth and the puerperium. Review

The review discusses the possibilities of predicting preeclampsia and its complications, modern criteria for the diagnosis of gestational hypertensive disorders and tactics of their intensive therapy. Particular attention was devoted on the anesthetic management for cesarean section in a woman with preeclampsia and its complications. The information proposed in the review makes it possible to define a unified terminology and form unified evidence-based interdisciplinary approaches to the diagnosis and treatment of preeclampsia, which will improve maternal and fetal outcome.

Anesthetic Management of Cesarean Section for Parturient with Takayasu’s Arteritis

Anesthetic Management of Cesarean Section for Parturient with Takayasu’s Arteritis

Anesthetic management for cesarean section in a patient receiving transplacental treatment of fetal tachyarrhythmia: a case report

BackgroundAlthough rare, long-lasting fetal tachyarrhythmia often leads to fetal heart failure and hydrops. Some mothers receive transplacental treatment of fetal tachyarrhythmia (TTFT), which can potentially worsen maternal hypotension and bradycardia. Moreover, the use of rescue cardiovascular agents intraoperatively can worsen fetal tachycardia. However, reports of the anesthetic management of patients receiving TTFT are rare.Case presentationA 31-year-old woman who was receiving digoxin and sotalol for TTFT underwent planned elective cesarean section. The fetus had hypoplastic left heart syndrome, hydrops, and tachycardia. We used combined spinal-epidural anesthesia with a reduced dose of local anesthetic. We also employed a non-invasive continuous hemodynamic monitoring system. The mother’s systolic blood pressure remained at ≥ 90% of the baseline value; intraoperative administration of rescue cardiovascular agents was not required.ConclusionsWe successfully anesthetized a woman for cesarean section, who was receiving TTFT for fetal tachyarrhythmia, using combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring.

Anesthetic management of cesarean section in parturients with severe mitral stenosis: A case series

Mitral stenosis (MS) is the most common valvular heart disease associated with pregnancy. The increase in cardiac output during pregnancy results in deterioration of the patient's condition with progress to higher New York Heart Association class. Both general and regional anesthesias have been described for cesarean section in these patients. Anesthetic management of these patients depends upon the severity of the disease. General anesthesia has traditionally been preferred for cesarean section in patients with severe MS. Regional anesthesia has become popular as a safe choice in the recent past for cesarean section in all parturients including those with heart disease. We report three parturients with severe MS who underwent cesarean delivery under graded epidural block successfully. The parturients and the neonates were fine after the procedure.

Successful Anaesthetic Management of Caesarean Section: An Experience on a Patient with Myasthenia Gravis and Difficult Airway

The anaesthetic management of the pregnant woman with myasthenia gravis (MG) is very challenging to the anaesthesiologist. This situation becomes exaggerated in emergency settings in a low resource area, especially when attending anesthesiologists for the first time took care of her. Here, we present a case that illustrates this situation. A G3 P2 pregnant woman presented for an emergency caesarean section (CS) due to premature rupture of the membranes. The patient had been misinformed by her neurophysician not to undergo general anaesthesia at CS. She had no motor weakness and no bulbar symtoms. The only abnormal finding was a stiff neck and a Mallampati #2 score, which predicted a difficult airway. Spinal anaesthesia was not successful after several attempts. General anaesthesia was considered but again intubation was not successful. We performed anesthesia with a second generation laryngeal mask airway with successful CS. Pregnant women with MG require personalised care from a multidisciplinary team. While regional anaesthesia is reported to be the better choice in CS for women with MG, regional anesthesia is not always possible. Anesthesia should be chosen in a patient-by-patient manner. The present case illustrates such conditions, of which description may be useful for anesthesiologists and obstetricians.

Case Report: Anesthetic management for Cesarean section in a parturient with unspecified inherited bleeding disorder

Neuraxial anesthesia, as the standard of care for Cesarean deliveries, is associated with decreased blood loss. However, parturients with inherited bleeding disorders are at increased risk for epidural hematomas. A small retrospective study has shown that parturients with known factor deficiencies can safely undergo neuraxial anesthesia once the specific factors are replenished. We present a patient who had a considerably increased risk of peripartum bleeding from an unspecified inherited bleeding disorder and was provided a successful neuraxial anesthetic without complications. We discuss the multidisciplinary approach among the surgeons, anesthesiologists, hematologist, and nursing staff to maximize patient safety and comfort.