Ochukpue Ceejay
The University of Benin Teaching Hospital, Benin City, Nigeria
Title: Anaesthetic Management of a Parturient with Pulmonary Oedema for Emergency Caesarean Section: A Case Report.
Biography
Biography: Ochukpue Ceejay
Abstract
INTRODUCTION: Pulmonary oedema occurs when fluid leaks from the pulmonary capillary network into the lung interstitium and alveoli.
CASE DESCRIPTION: R.O, a 27 year- old para 2+0 who was referred to the University of Benin Teaching Hospital, Benin City, Nigeria from a peripheral centre at 35+3 weeks gestation with a history of sudden onset of difficulty in breathing and non-productive cough of one hour duration.
She was diagnosed hypertensive at 20 weeks gestation and placed on tabs methydopa 250mg 8hourly. There was a history of pregnancy induced hypertension during the first confinement in 2005.
On examination, she was in respiratory distress (RR-40cpm) with bilateral pitting pedal oedema. She was also tachycardic (125bpm, regular and good volume) and had a blood pressure of 180/80mmHg. There was good air entry with bilateral basal crepitation on auscultation of the chest. First and second heart sounds were heard and there were no murmurs. Abdominal examination revealed a uterine size of 34weeks with a cephalic presenting singleton foetus and a foetal heart rate of 165bpm (regular).
A diagnosis of pulmonary oedema secondary to severe preeclampsia was made. She was counseled for emergency caesarean section. Optimisation was commenced with intravenous labetalol 25mg stat, intravenous magnesium sulphate 4g and 1g/hr subsequently. Intravenous frusemide 100mg stat was also given.
The investigations revealed a haemoglobin level of 11.8gdl, white blood cell count of 19,000cells/mm3 platelet count of 176,000cells/mm3, urea 24mg/dL, creatinine 0.6mg/dL and proteinuria of 2++. She was reviewed by the duty anaesthesiologists, gave consent for general anaesthesia and was transferred to the labour ward theatre. Oropharyngeal structures were in keeping with Mallampati II and she was classified ASA IVE.
In the theatre, the anaesthetic machine and ancillary equipment with resuscitation drugs were prepared. She had acid prophylaxis (intravenous ranitidine 50mg, 10mg metoclopramide). A multi-parameter monitor was attached and baseline vital signs showed a pulse rate of 96bpm, blood pressure of 114/76mmHg and oxygen saturation (Sp02) of 84% on 100% oxygen. The electrocardiogram was normal.
Rapid sequence induction of anaesthesia with Sellick’s manoeuver was the technique of choice. She was preoxygenated with 100% oxygen. Induction of anaesthesia was with 300mg of sodium thiopentone, endotracheal intubation was facilitated with 100mg of suxamethonium using a size 7.5mm ID cuffed portex endotracheal tube and 500mls of frothy sputum was suctioned from it. Anaesthesia was maintained with 0.8% isoflurane in 100% oxygen and neuromuscular blockade was achieved using 30mg atracurium.