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Obata N, Nakai E, Makino S, Mizobuchi S. Perioperative Management of a Needle-Phobic Parturient for a Cesarean Section: A Case Report. Cureus 2024; 16:e59032. [PMID: 38800202 PMCID: PMC11128030 DOI: 10.7759/cureus.59032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
We describe the perioperative management of a pregnant woman with severe needle phobia who underwent a cesarean section. General anesthesia with slow induction using an inhalant anesthetic for cesarean section is a rare and unique situation. Furthermore, the management of this case was more complicated because the patient not only refused the puncture procedure but also refused the presence of an indwelling object when she woke up from the anesthesia. After the operation, the patient was admitted to the intensive care unit (ICU) and received mechanical ventilation under deep sedation. The patient was managed under sedation until the day after surgery, and both mother and child progressed without perioperative complications.
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Affiliation(s)
- Norihiko Obata
- Department of Anesthesiology, Kobe University Hospital, Kobe, JPN
| | - Eri Nakai
- Department of Anesthesiology, Hyogo Prefectural Kobe Children's Hospital, Kobe, JPN
| | - Shohei Makino
- Department of Anesthesiology, Kobe University Hospital, Kobe, JPN
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Ha C, Naftalovich R, Chaudhry F, Eloy J, Spano E, Tewfik G. Use of a Superficial Abdominal Wall Vein in a Gravida Patient for Emergency Vascular Access. Case Rep Anesthesiol 2023; 2023:1514940. [PMID: 37293548 PMCID: PMC10247316 DOI: 10.1155/2023/1514940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Obtaining vascular access through a superficial vein of the abdominal wall of a gravida patient is an option in an emergency Cesarean surgery when other means fail. Such superficial veins may be mistaken for striae gravidarum on physical exam. A small intravenous (IV) cannula is not ideal but could save valuable time and avoid delaying induction of general anesthesia. Once the airway is secured, a larger bore IV can then be inserted while surgical exposure is undergoing. Analysis of the risks and benefits of inducing general anesthesia with a small gauge IV for a gravida patient should take into consideration risk factors for massive peripartum hemorrhage such as placental disorders (accreta, increta, precreta, abruption, or previa), presence of uterine fibroids, preeclampsia, hemolysis, elevated liver enzymes, low platelet count (HELP syndrome), severe polyhydramnios, history of grand multiparty, and bleeding disorders such as Von Willibrands and hemophilia.
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Affiliation(s)
- Christine Ha
- Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA
| | - Rotem Naftalovich
- Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA
- US Army Medical Corps, Fort Sam Houston, San Antonio, TX, USA
| | - Faraz Chaudhry
- Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA
| | - Jean Eloy
- Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA
| | - Erica Spano
- Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA
| | - George Tewfik
- Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA
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Parrott N, Prabhu P, Yeow C. Inhalational induction of general anaesthesia for elective caesarean: ethical acceptability in treatment-resistant needle phobia? Int J Obstet Anesth 2020; 43:27-29. [PMID: 32570047 DOI: 10.1016/j.ijoa.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Abstract
We describe the anaesthetic management of a parturient who, due to a severe needle phobia, requested an inhalational induction of general anaesthesia for an elective caesarean section. If general anaesthesia is indicated, conventional practice in the UK is to perform a rapid sequence induction via an intravenous route of drug administration to allow rapid intubation of the trachea. This is because obstetric patients are considered to have a 'full stomach' due to the effects of pregnancy and labour on gastric emptying, and a higher risk of aspiration with consequent maternal and fetal adverse outcomes. Despite a thorough consent process highlighting these significant risks, the patient insisted on an inhalational induction of anaesthesia. We present the case and discuss the ethical dilemma (relating to patient care) in situations in which decisions made by patients deviate from medical recommendations.
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Affiliation(s)
- N Parrott
- Department of Anaesthesia, Royal Surrey County Hospital, Guildford, United Kingdom.
| | - P Prabhu
- Department of Anaesthesia, Royal Surrey County Hospital, Guildford, United Kingdom
| | - C Yeow
- Department of Anaesthesia, Royal Surrey County Hospital, Guildford, United Kingdom
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Abstract
BACKGROUND Sevoflurane is often presented as a near-perfect anaesthetic. After 10 years in the operating room, new uses are emerging outside. OBJECTIVE To remind readers of the principal characteristics of sevoflurane, to affirm its usefulness for day-case anaesthesia and to consider the recent new uses. METHODS The discussion of the physical properties, pharmacokinetics, metabolism, mechanisms of action and clinical effects is based on classic, essential papers. Recent literature concerning emerging utilizations of sevoflurane was analysed. RESULTS Sevoflurane presents many benefits with minimum inconvenience. It allows rapid inhalation induction, maintenance and rapid recovery. It has little toxicity and its haemodynamic and respiratory depressive effects are moderate and well tolerated. It is already widely use for sedation for magnetic resonance imaging in children. Its use in paediatric or adult intensive care could improve the management of pain and sedation.
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Affiliation(s)
- Fabrice Michel
- Faculty of Medicine, Paediatric and Neonatal Intensive Care Unit, University of the Mediterranean, North University Hospital, Marseille Cedex 20, France.
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McClelland SH, Hardman JG. Inhalational induction of anaesthesia in adults: time for a breath of fresh air? Anaesthesia 2007; 62:1087-9. [PMID: 17924886 DOI: 10.1111/j.1365-2044.2007.05343.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thörn K, Thörn SE, Wattwil M. The effects on the lower esophageal sphincter of sevoflurane induction and increased intra-abdominal pressure during laparoscopy. Acta Anaesthesiol Scand 2006; 50:978-81. [PMID: 16923093 DOI: 10.1111/j.1399-6576.2006.01069.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Today sevoflurane is one of the most frequently used volatile anesthetics. The speed of induction can approach that of intravenous anesthetics, and case reports using sevoflurane induction for emergency anesthesia have been published. The purpose of this study in laparoscopic cholecystectomy patients was to investigate the effects of sevoflurane during inhalation induction on the lower esophageal sphincter pressure (LESP) and barrier pressure (BrP). The effects on lower esophageal sphincter (LES) and BrP of increased intra-abdominal pressure during laparoscopy were also evaluated. METHODS We recorded LESP and BrP in nine patients using a Dent sleeve device. Recordings were made before and after inhalation induction of anesthesia with 8% sevoflurane, as well as before and after insufflation of CO(2) into the abdomen. RESULTS After induction with sevoflurane, LESP (P= 0.039) and BrP (P= 0.020) decreased. Nevertheless, BrP was kept positive in all patients. Insufflation of CO(2) into the abdomen during laparoscopy induced a significant increase in LESP (P= 0.02) and gastric pressure (P= 0.004). However, there was no significant change in BrP (P= 0.66); it increased in four patients and decreased in five. CONCLUSION BrP was kept positive in all patients after induction of anesthesia. Therefore, we believe that in combination with cricoid pressure, inhalation induction with sevoflurane might be a safe choice. As the adaptive increase in LESP during laparoscopy was not enough to retain a barrier pressure in all patients, it is important to be aware of the risk of regurgitation throughout the anesthesia.
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Affiliation(s)
- K Thörn
- Department of Anesthesiology and Intensive Care, Orebro University Hospital, Orebro, Sweden.
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Karaman S, Akercan F, Aldemir O, Terek MC, Yalaz M, Firat V. The maternal and neonatal effects of the volatile anaesthetic agents desflurane and sevoflurane in caesarean section: a prospective, randomized clinical study. J Int Med Res 2006; 34:183-92. [PMID: 16749414 DOI: 10.1177/147323000603400208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study compared maternal and neonatal outcomes in women undergoing elective caesarean section under general anaesthesia with desflurane or sevoflurane; the neonatal effects were also compared with those in women undergoing epidural anaesthesia. Fifty women requesting general anaesthesia were randomly assigned to receive either 3% desflurane or 1% sevoflurane. Twenty-five women requesting regional anaesthesia received epidural anaesthesia with ropivacaine. Comparing desflurane sevoflurane with respect to their maternal haemodynamic effects, maternal blood pressure levels were higher and tachycardia was more frequent in the desflurane group. Comparing general and epidural anaesthesia, no significant differences were detected in terms of neonatal Apgar scores or neurological adaptive capacity scores. In conclusion, 3% desflurane or 1% sevoflurane for general anaesthesia and ropivacaine for epidural anaesthesia for elective caesarean section had similar effects on neonatal outcomes. In women who received desflurane, blood pressure and heart rate elevation were significantly higher than in the sevoflurane group, though this difference did not have any clinical importance.
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Affiliation(s)
- S Karaman
- Department of Anaesthesiology and Reanimation, Ege University Faculty of Medicine, Izmir, Turkey.
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Kuczkowski KM. Inhalation induction of anesthesia with sevoflurane for emergency Cesarean section in an amphetamine-intoxicated parturient without an intravenous access. Acta Anaesthesiol Scand 2003; 47:1181-2. [PMID: 14518499 DOI: 10.1034/j.1399-6576.2003.t01-2-00226.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Gaiser RR. Changes in the provision of anesthesia for the parturient undergoing cesarean section. Clin Obstet Gynecol 2003; 46:646-56. [PMID: 12972746 DOI: 10.1097/00003081-200309000-00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Robert R Gaiser
- Anesthesiology and Pharmacology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Levy DM. Inhalational induction of anaesthesia for caesarean section: not to besniffed at? Int J Obstet Anesth 2002; 11:235-7. [PMID: 15321526 DOI: 10.1054/ijoa.2002.0987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Simon GR, Wilkins CJ, Smith I. Sevoflurane induction for emergency caesarean section: two case reports in women with needle phobia. Int J Obstet Anesth 2002; 11:296-300. [PMID: 15321533 DOI: 10.1054/ijoa.2002.0961] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Needle phobia is an unusual but well-recognised clinical entity. It is claimed that it may affect up to 10% of the general population and may prevent potential patients from seeking medical care, thereby reducing its apparent incidence in the hospital population. Its occurrence in a parturient requiring urgent caesarean section presents special challenges to the anaesthetist. This report discusses the clinical, ethical and medico-legal dilemmas presented by two such cases that were successfully managed by inhalational induction of general anaesthesia using sevoflurane.
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Affiliation(s)
- G R Simon
- Department of Anaesthesia, North Staffordshire Hospital, Stoke-on-Trent, UK.
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Abstract
We present a brief overview of recent literature concerning some of the drugs used in pregnancy, labour and delivery. Obstetric anaesthesia continues to evolve through the reuse of old drugs such as magnesium sulphate or the manipulation of current drugs (e.g. propofol for emesis) in order to improve patient outcome. Pregnant women have traditionally been therapeutic orphans. The use of new agents such as levobupivacaine and ropivacaine in obstetric patients lags behind that of their non-pregnant counterparts. However, this gap is decreasing and these new drugs offer benefits to the parturient woman.
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Affiliation(s)
- P B Cox
- Department of Anaesthesiology, Academisch Ziekenhuis Maastricht, Maastricht, The Netherlands
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Delgado-Herrera L, Ostroff RD, Rogers SA. Sevoflurance: approaching the ideal inhalational anesthetic. a pharmacologic, pharmacoeconomic, and clinical review. CNS DRUG REVIEWS 2001; 7:48-120. [PMID: 11420572 PMCID: PMC6741648 DOI: 10.1111/j.1527-3458.2001.tb00190.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sevoflurane is a safe and versatile inhalational anesthetic compared with currently available agents. Sevoflurane is useful in adults and children for both induction and maintenance of anesthesia in inpatient and outpatient surgery. Of all currently used anesthetics, the physical, pharmacodynamic, and pharmacokinetic properties of sevoflurane come closest to that of the ideal anesthetic (200). These characteristics include inherent stability, low flammability, non-pungent odor, lack of irritation to airway passages, low blood:gas solubility allowing rapid induction of and emergence from anesthesia, minimal cardiovascular and respiratory side effects, minimal end-organ effects, minimal effect on cerebral blood flow, low reactivity with other drugs, and a vapor pressure and boiling point that enables delivery using standard vaporization techniques. As a result, sevoflurane has become one of the most widely used agents in its class.
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Affiliation(s)
- L Delgado-Herrera
- Abbott Laboratories, Hospital Products Division, 200 Abbott Park Road, Abbott Park, IL 60064, USA.
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Abstract
All commonly used anesthetic agents and drugs undergo placental transfer. Understanding the placental transfer of anesthetic drugs and their effects on the neonate is essential for optimal administration of both regional and general anesthesia. Regional anesthesia is decidedly safer for the mother and, when properly performed, actually may be beneficial to the stressed neonate. The healthy neonate also benefits from maternal analgesia during labor and delivery. General anesthesia may result in transient neonatal depression, particularly when delivery is of an emergency nature. The skill and knowledge of the anesthesiologist are more important than the type of anesthesia administered. Therefore, when properly performed, both regional and general anesthesia are quite safe in terms of neonatal outcome.
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Affiliation(s)
- J G D'Alessio
- Department of Anesthesiology, University of Tennessee, Memphis, USA
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SEVOrane®- Safety in anesthesia. Acta Anaesthesiol Scand 1997. [DOI: 10.1111/j.1399-6576.1997.tb04895.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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