Anaesthetic Management of Cervical Spine Surgery for Traumatic Tetraplegia in 32 Weeks Pregnant Patient: A Case Report and Literature Review.
Journal Title: International Journal of Medical Science And Advanced Clinical Research (IJMACR) - Year 2019, Vol 2, Issue 1
Abstract
A 30 year old woman with 32 weeks pregnancy and hypothyroidism admitted in the hospital with traumatic cervical SCI (Spinal Cord Injury) with quadriplegia but intact sensation (ASIA-B). Patient was haemodynamically unstable. Immediately intravenous fluid (IVF), Dopamine infusion and Oxygen by mask were started to improve spinal cord and placental circulation and oxygenation. Injection Methylprednisolone 1 gm infusion was given. injection Dexamethosone 12 mg intravenous(IV) stat was given and then repeated after 12 hrs it improve foetal circulation and lung maturation of developing foetus. Injection Isoxsuprine Hydrochloride was started to prevent premature labour.Standby Obstetrician and Paediatrician were requested during spine surgery. Morning dose of injection Isoxsuprine 10 mg slow IV was given before shifting the patient to the Operation Theatre (OT). Anaesthesia was induced with Propofol and Rocuronium. Manual in-line axial stabilization was maintained during intubation. Anaesthesia was maintained with Mechanical Ventilation, Oxygen, Air, Isoflurane and Ketofol (Ketamine and Propofol in 1:5 ratio). Nitrous oxide was avoided because it increases the risk intracranial haemorrhage in premature foetus and may affect DNA synthesis. Foetal monitoring was done throughout the procedure. After the surgery patient was reversed and extubated. Prophylactic tocolytic therapy was re-started in recovery room. Injection Enoxaparin 40 mg subcutaneous(s/c) given for 15 days.At 36 weeks of pregnancy, hospital arranged Paediatric team and incubator from outside. No sedation was given in premedication. Caesarian section was done under GA and normal healthy girl baby was delivered. Now patient is able to stand and walk without support.
Authors and Affiliations
Dr Parashuram Chauhan
Keywords
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