Anesthesia Management in an Eclampsia Patient
Robert H Sirait *
Department of Anesthesiology, Faculty of Medicine Universitas Kristen Indonesia & Rumah Sakit Umum Universitas Kristen Indonesia, Jakarta, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Eclampsia is always considered as a very serious complication of pregnancy which is responsible for numerous maternal and perinatal mortality in global setting. Eclampsia is characterized by seizures in a pregnant or postpartum patient as a result of hypertension. It is an escalation of preeclampsia, which is characterized by high blood pressure associated with pregnancy and is usually accompanied by protein in the urine. This report a case of eclampsia diagnosed in a pregnant woman which underwent anaesthesia management prior to section caesarea. Role of an anesthesiologist in this case is basically to help the obstetrician in charge to prepare the patient for safe operation and prevent any complication. The case is being reported to improve awareness regarding this life threatening entity in women.
Case Presentation: A 27 years old (G2P0A1) patient at 36 weeks of gestation, referred to our ER with a history seizure, reduced consciousness with a bitten tongue and gestational hypertension. Her vital signs: NIBP 185/115 mmHg, HR: 90 beats/minute, RR 38x/minute, SpO2 96-97% on NRM 10 lpm. The patient has been infusion with a 5% Dextrose + 6 g MgSO4 (2 g IV + 4 g drip) and a 100 ml Dower Catheter from the regional general hospital. Working diagnosis when admitted to our hospital was 36 weeks of pregnancy G2P0A1 with severe eclampsia and gestational hypertension.
Physical and laboratory examinations showed that the lungs showed smooth wet rhonchi (+/+), then on the extremities there were bilateral leg edema with hemoglobin of 10.8 g/dL, hematocrit 33.9%, platelet count was 85.000/mm3, and proteinuria +2. The clinico-pathologic features were consistent with the diagnosis of eclampsia. The patient was planned for Sectio Caesaria (SC) Cito with general anesthesia. After 7 minutes incision, the baby was born with an APGAR ssore 6/9. The operation procedure took 40 minutes. After surgery the patient transferred to ICU room, connect to ventilator, infusion of MgSO4 was continued, hemodynamic improvement, awareness, extubated, and then discharge from ICU because the anticipated medical complications did not arise and the patient has been deemed fit for step down care.
Keywords: Seizure, gestational hypertension, proteinuria, sectio caesaria, general anesthesia, intensive care unit