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Local-anaesthetics Decrease in systemic vascular resistance following exposure during delivery: case report

A 22-year-old pregnant woman exhibited a decrease in systemic vascular resistance following neuraxial anaesthetic therapy with bupivacaine, fentanyl, lidocaine and morphine. The nulliparous woman was admitted at 29 weeks of gestation due to a 2-day history of chest pressure and mild shortness of breath. Based on the presenting symptoms and lab results, a provisional diagnosis of HELLP syndrome or pulmonary hypertensive crisis with hepatic congestion was made [aetiology not stated]. In view of maternal decompensation, she was scheduled for an emergent caesarean section under neuraxial anesthesia. For this, a multidisciplinary team including maternal-fetal medicine specialist, obstetric and cardiothoracic anesthesiologists, pulmonary hypertension cardiologist, extracorporeal membrane oxygenator (ECMO) surgeon, perfusionists and a critical care obstetric nurse was consulted. She thus was scheduled for the caesarian section and received premedication with nitric oxide, diphenhydramine and furosemide. She the received neuraxial anaesthetic therapy using intrathecal hyperbaric bupivacaine 5mg, fentanyl 15µg and morphine 200µg followed by epidural lidocaine 2% (15mL) over 23 minutes. Seventeen minutes after the local anaesthetic block, she received phenylephrine 160µg and IV ephedrine 10mg for management of pulmonary pressure. Meanwhile, she also exhibited a decrease in systemic vascular resistance, which was determined to be induced by neuraxial anaesthesia [time to reaction onset not stated]. The woman received norepinephrine 2 µg/min for the neuraxial anaesthesia-induced decreased systemic vascular resistance. After two minutes, a surgical incision was performed, and a neonate was eventually delivered with an Apgar score of 8/9 [sex of the neonate not stated]. Meng ML, et al. Adding to the Denominator: A Case Report of Neuraxial Anesthesia for Cesarean Delivery in the Setting of Hemolysis, Elevated Liver Enzyme, Low Platelet, Thrombocytopenia, and Pulmonary Hypertension. A and A Practice 14: 144-148, No. 5, 1 Mar 2020. Available from: URL: http://doi.org/10.1213/ XAA.0000000000001168 803515155

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Reactions 14 Nov 2020 No. 1830