Anesthesia for cesarean section in eclamptic parturients with obtunded consciousness at a remote place with limited resources

Abstract

Eclampsia, characterized by a convulsive disorder with pre-eclampsia before during or after labor has an unpredictable outcome with high morbidity and mortality. Controversies still exist in the management of eclampsia, both from the obstetric and anesthesia point of view. The definitive treatment is termination of pregnancy. The choice of anesthesia for a lower segment cesarean section (LSCS) between regional (spinal or epidural) and general anesthesia remains controversial. General anesthesia is usually preferred in eclamptic patients with convulsions, as patients may be unconscious and might have raised intracranial pressure, coagulopathy and pulmonary edema. Spinal anesthesia is well established in conscious stable eclamptic but its role in unstable eclamptic patient has not been documented.

We present the safe and successful conduct of two cases of urgent LSCS in convulsing eclamptic parturients under spinal anesthesia at a remote location with infrastructure constraints like trained manpower, critical care and laboratory facilities etc. Both became conscious subsequently and their postoperative course was uneventful.

Key words: Eclampsia; Convulsions; Anesthesia, Spinal; Anesthesia, General; Thrombocytopenia

Citation: Gupta P, Sahni A. Anesthesia for cesarean section in eclamptic parturients with obtunded consciousness at a remote place with limited resources. Anaesth Pain & Intensive Care 2016;20(3):361-364

Received: 1 September 2016; Reviewed: 12 September 2016; Accepted: 15 September 2016