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Published:
Jul 10, 2013Keywords:
Hypno-sedation hyperthyroidism spinal anaesthesia caesarean section
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Anaesthetic Challenges In An Untreated Grave's Disease Parturient Undergoing Emergency Caesarean Section
Abstract
Background: The evaluation and management of hyperthyroidism in pregnancy is challenging to perioperative care givers. The objective of this report was to demonstrate the role of single shot spinal anaesthesia in managing the haemodynamic challenges associated with untreated Graves ' disease in pregnancy.
Method: Following a 500mls preload with normal saline, patient received 10mg of plain bupivacaine in the lateral position. Continuous monitoring of blood pressure, pulse rate, ECG, temperature, oxygen saturation was carried out throughout the procedure and into the post-operative period.Hypno-sedation was applied as required.
Results: At the end of surgery, there was a decrease in the pulse pressure from 94mmHg to 81mmHg. Also the pulse rate decreased from 156beats/min to 121beats. Patient was transferred to the Intensive Care Unit for a few days and subsequently discharged and followed up in the Medical out-patient clinic.
Conclusions: Uncontrolled Hyperthyroidism coexisting with pregnancy is very challenging to perioperative care givers. However surgery can be safely performed using a single-shot spinal anaesthesia with bupivacaine and hypno-sedation in addition to the application of background disease pathophysiology and complications in managing the associated haemodynamic challenges.
Keywords: Hypno-sedation, hyperthyroidism, spinal anaesthesia, caesarean section
Method: Following a 500mls preload with normal saline, patient received 10mg of plain bupivacaine in the lateral position. Continuous monitoring of blood pressure, pulse rate, ECG, temperature, oxygen saturation was carried out throughout the procedure and into the post-operative period.Hypno-sedation was applied as required.
Results: At the end of surgery, there was a decrease in the pulse pressure from 94mmHg to 81mmHg. Also the pulse rate decreased from 156beats/min to 121beats. Patient was transferred to the Intensive Care Unit for a few days and subsequently discharged and followed up in the Medical out-patient clinic.
Conclusions: Uncontrolled Hyperthyroidism coexisting with pregnancy is very challenging to perioperative care givers. However surgery can be safely performed using a single-shot spinal anaesthesia with bupivacaine and hypno-sedation in addition to the application of background disease pathophysiology and complications in managing the associated haemodynamic challenges.
Keywords: Hypno-sedation, hyperthyroidism, spinal anaesthesia, caesarean section
