Oxytocin
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Uvular oedema, and swelling of the soft palate and tongue: case report A 29-year-old woman developed massive uvular oedema, and swelling of the soft palate and tongue following the administration of oxytocin during delivery. The pregnant woman was admitted for twin delivery. She received infusion of oxytocin [dose administered not stated]. Subsequently, she spontaneously delivered the first baby. She delivered the second baby following forceps use and episiotomy. Within a few hours, her haemoglobin dropped, she developed uterine atony, hypotension and acute kidney injury with mild metabolic acidosis. She received balanced salt solution and RBC transfusion was started. She was then moved to operation theatre. She received general anaesthesia with rapid sequence induction, and a McGrath MAC Video Laryngoscope was used for intubation. The view of laryngoscopic was grade-1, with some soft tissue oedema. A bougie was used to place a cuffed tracheal tube (size 7.0). Additionally, the tube required a gentle rotation under vision to overcome some resistance at the right arytenoid cartilage. Uterine atony was managed using a Bakri balloon, and the episiotomy was re-sutured. The estimated blood loss was of 4L, and she received 6 units of packed RBCs, 4 units of fresh frozen plasma, one pooled platelet pack, fibrinogen concentrate and tranexamic acid. On waking up after extubation , she complained of a marked foreign body in the throat with difficulty in swallowing. Markedly swollen uvula was noted, and its lower margin was not visible [duration of treatment to reaction onset not stated]. When she coughed, a massively swollen and elongated uvula came out, which was folded on itself and sat over the base of the tongue. Also, an associated swelling of the soft palate and tongue was observed. Following ENT consultation, the woman was started on dexamethasone. The kidney injury resolved within 24 hours, and the oedema improved in the following two days. She was then discharged, and the condition resolved completely in the following days. Sharma R, et al. Massive uvular edema in a parturient after general anesthesia. International Journal of Obstetric Anesthesia 44: 22-23, Nov 2020. Available from: URL: 803498370 https://doi.org/10.1016/j.ijoa.2020.05.008
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Reactions 29 Aug 2020 No. 1819
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