Anesthetic Technique and Resuscitation of a 38 Weeks Pregnant Patient with Established Anaphylactic Reaction-A Mysterious Case Report

Authors: Debabrata Banik*, Joysree Roy, AKM Faizul Haque, AKM Habibullah, Mehdi Hassan and Moumita

DOI: 10.23880/accmj-16000161

Volume 4, Issue 4

Abstract

Introduction: Anaphylaxis reactions in pre-anesthetic period of 38 week of pregnant women are challenging for the anaesthesiologist who is dealing with anesthesia for urgent LSCS and resuscitation for both.. Anaphylaxis in pregnancy is uncommon condition with a prevalence of 2.7 cases/1 00 000 deliveries.1-4 Aims of this case report is to realize the outcome of pregnant women with pre anesthetic anaphylaxis and find out the most effective anesthetic technique and management of pregnant patient. Case: A 28 years old pregnant women was admitted for elective caesarian section and prophylactic cefuroxime sodium 1.5 gm given intravenously. The patient complained of restlessness, itching and respiratory distress which was improved by steroid. In the operation table all monitoring were attached, oxygen was given by nasal cannula, iv channel established and monitors were showing SPO2 99-100% pulse 135-140 /min however, obstetrician didn’t find fetal heart sound by fetoscope and stethoscope. Resuscitation and Anesthesia: Anaesthesiologist started immediate resuscitation considering anaphylactic reaction but improvement was very slow and consulted with obstetrician for communications with patient party regarding patient and fetal conditions with possible outcome, baby was delivered by LSCS with local infiltration anesthesia and supplement systemic analgesic. Result: After delivery of the fetus all possible resuscitation efforts were taken but the baby didn’t survive but the mother was improving. Mother was transferred to ICU discharged with full recovery after 2r hours. Conclusion: It was may be slower onset presentation of anaphylactic reaction to cephalosporin antibiotic. It is a so rare case, proper management procedure and monitoring of mother and fetus was very difficult. Anesthetic technique for LSCS of established anaphylactic shock’s pregnant patient is very challenging but it was successfully managed by local infiltration anesthesia with systemic analgesic.

Keywords: Anaphylactic reaction; Cephalosporins; Pregnant patient; Local infiltration anesthesia

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