Anesthetic management in Impending Eclampsia with Intracranial Pathology

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Anesthetic management in Impending Eclampsia with Intracranial Pathology

   

Srashti Singh1* and  Sandeep Kadam2

13RD Yr. Resident, Department  of Anaesthesia, Dr Dypatil Hospital and Research Centre, Kolhapur (Mh), India

2Professor and HOD at Department  of Anaesthesia, Dr Dypatil Hospital and Research Centre, Kolhapur (Mh), India

*Corresponding author: Srashti Singh, 3RD Yr. Resident, Department of Anaesthesia, Dr Dypatil Hospital And Research Centre, Kolhapur (Mh), India

Citation: Singh S, Kadam S. (2022) Anesthetic management in Impending Eclampsia with Intracranial Pathology. Adv Clin Med Res. 3(4):1-4.

Received: October 13,  2022 | Published: October 25, 2022

Copyright© 2022 by Singh S. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Introduction

Intracranial bleed is rare yet devastating event in pregnancy. There are risk of maternal mortality/morbidity and poor fetal outcome. Intracranial hemorrhage can be subdural, extradural, subarachnoid, intraparenchymal. Causes of bleeding include trauma, jaundice, preeclampsia, eclampsia, venous thrombosis. Urgent neurosurgical, obstetrician and anesthetic intervention needs to be taken for better maternal and fetal outcome.

Case Presentation

We report a case of 22 yrs. old primigravida patient with 34 week of gestation came to hospital with complaint of giddiness and 2 episodes of vomiting since morning. Her GCS was 10/15. Patient was diagnosed with Impending Eclampsia with fetal de-stress and provisional diagnosis of ICH. Prichard regimen (mgso4) was given. Emergency lower segment cesarean section was done in view of fetal de-stress and Right sided de-compressive emergency craniotomy was done later [1,2].

On examination

  • Patient was irritable
  • Temperature Afebrile
  • Heart Rate : 110 bpm
  • Blood pressure : 140/90 mmHg
  • CVS : S1S2 heard
  • RS : AEEBS
  • No pallor, no icterus, no cyanosis, no oedema.

Investigations

  • CBC :Hb 12.8 gm/dl , Plt 1,47,000 ,
  • TLC 7,800.
  • RFT  : Urea 18.7 , Creatinine 0.8
  • LFT : WNL
  • PT/INR : 14/14/1.10
  • ECG :WNL

Management

  • Difficult airway cart and emergency drugs were kept ready , informed valid written consent , high risk consent were taken. Premedication with Inj. Glycopyrrolate 0.2mg, Inj. Ondansetron4mg , Inj. fentanyl 50 mcg , Inj. Loxicard 60 mg i/v was given.
  • general anesthesia was given using rapid sequence intubation using video laryngoscope .
  • Induction was done. Inj. Propofol 100mg and Inj. Succinylcholine100mg, Intubation was done using cuffed endotracheal tube no. 7.00 cm, Patient was maintained on O2 + Air+ Sevoflurane and vecuronium.
  • After delivering of baby, inj. Loxicard 60 mg iv and inj. Fentanyl 50 mcg iv was given.
  • After completion of surgery patient was extubated shifted to SICU.
  •  Later on next morning patient became drowsy again .emergency neurologist opinion was taken and MRI was done which showed ICH. Patient was immediately shifted to operation theater and right sided de-compressive surgery was done , after completion of surgery patient was shifted to sicu and electively ventilated for 3 days on SIMV and later extubated.
  • Patient neurologically improved and comes for follow up .
  • Both mother and baby are healthy.

On MRI

Large temporal lobe capsuloganglionic intracerebral hematoma (80*42mm), Effacement of ipsilateral right lateral ventricle, midline shift of approx.1.2 cm towards left suggestive of falcine herniation (Figure 1).