Anaesthetic management for emergent upper limb trauma surgery in a 23-week pregnant woman: Role of ultrasound-guided infraclavicular brachial plexus block. Case report
Keywords:
Pregnant women, Conduction anesthesia, Brachial Plexus, Nerve block, Analgesia
Abstract
We describe the anaesthetic management of a 34-year-old woman at 23 weeks of gestation with a forearm tendon and vascular injury who required an emergent surgical repair. Brachial plexus nerve block avoids the potential risk of failed intubation and aspiration in addition to reducing the exposure of the foetus to potentially teratogenic drugs. Whenever feasible, a regional anaesthetic technique should be used. If general anaesthesia is mandatory, a rapid sequence induction is required. A multidisciplinary approach needs to be established early in the management of these patients. Anaesthetists must provide safe anaesthesia for both mother and child by maintaining adequate maternal oxygenation for avoiding foetal asphyxia.
References
1. Ní Mhuireachtaigh R, O'Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth. 2006;18:60-6.
2. Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth. 2011;107 Suppl 1:i72-8.
3. Bansal T, Kumar P, Hooda S. Anestesia regional: todavía una alternativa adecuada en la parturienta con obesidad mórbida. Rev Colomb Anestesiol. 2013;41:302-5.
4. Van de Velde M, de Buck F. Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol. 2007;73:235-40.
5. Brodsky JB, Cohen EN, Brown Jr BW, Wu ML, Witcher C. Surgery during pregnancy and fetal outcome. Am J Obstet Gynecol. 1980;138:165-7.
6. Kort B, Katz VL, Watson WJ. The effect of nonobstetric operation during pregnancy. Surg Gynecol Obstet. 1993;177:371-6.
7. Naughton NN, Cohen SE. Nonobstetric surgery during pregnancy. En: Chestnut DH, editor. Obstetric anesthesia: Principles and practice. 3rd ed. Philadelphia: Elsevier Mosby; 2004. p. 255-72.
8. Crowhurst JA. Anaesthesia for non obstetric surgery during pregnancy. Acta Anaesthesiol Belg. 2002;53:295-7.
9. Cohen SE. Nonobstetric surgery during pregnancy. En: Chestnut DH, editor. Obstetric anesthesia: Principles and practice. 2nd ed. St. Louis: Elsevier Mosby; 1999. p. 279.
10. Kress HG. Effects of general anaesthetics on second messenger systems. Eur J Anaesthesiol. 1995;12:83-97.
11. Sturrock JE, Nunn JF. Mitosis in mammalian cells during exposure to anesthetics. Anesthesiology. 1975;43:21-33.
12. Wang LP, Paech MJ. Neuroanesthesia for the pregnant woman. Anesth Analg. 2008;107:193-200.
13. Kuczkowski KM. Nonobstetric surgery during pregnancy: What are the risks of anesthesia? Obstet Gynecol Surv. 2004;59:52-6.
14. Horrigan TJ, Villareal R, Weinstein L. Are obstetrical personnel required for intraoperative fetal monitoring during nonobstetric surgery? J Perinatol. 1999;19:124-6.
15. ACOG. ACOG Committee on Obstetric Practice. Nonobstetric surgery in pregnancy. Obstet Gynecol. 2003;102:431.
16. Dardon JC, Herrera L, Pérez A. Estudio comparativo, prospectivo, longitudinal y aleatorio de tres técnicas de bloqueos cervicobraquiales para cirugía de extremidades superiores. Rev Mex Anest. 2000;23:7-10.
17. Vásques MI, Jiménez AM, Aguirre OD, González MP, Ríos AM. Bloqueo supraclavicular bilateral con ecografía. Rev Colomb Anestesiol. 2012;40:304-8.
18. Ortega Romero A, de Diego Isasa D, del Olmo Rodríguez C, Maroto Ramos E, Rouco Gil R. Ecografía portátil en anestesia regional: bloqueos del plexo braquial. Rev Esp Anestesiol Reanim. 2008;55:294-303.
19. Wilson JL, Brown DL, Wong GY, Ehman RL, Cahill DR. Infraclavicular brachial plexus block: Parasagittal anatomy important to the coracoid technique. Anesth Analg. 1998;87:870-3.
20. Perlas A, Chan VW, Simons M. Brachial plexus examination and localization using and electrical stimulation. Anesthesiology. 2003;99:429-35.
21. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7-17.
22. Bigeleisen P. Nerve puncture and apparent intraneural injection during ultrasound-guided axillary block does not invariably result in neurologic injury. Anesthesiology. 2006;105:779-83.
23. Naughton NN, Chitra CS. Nonobstetric surgery during pregnancy. In: Chestnut DH, editor. Obstetric anesthesia: principles and practice. Philadelphia: Elsevier Mosby; 2004. p. 255-72.
2. Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth. 2011;107 Suppl 1:i72-8.
3. Bansal T, Kumar P, Hooda S. Anestesia regional: todavía una alternativa adecuada en la parturienta con obesidad mórbida. Rev Colomb Anestesiol. 2013;41:302-5.
4. Van de Velde M, de Buck F. Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol. 2007;73:235-40.
5. Brodsky JB, Cohen EN, Brown Jr BW, Wu ML, Witcher C. Surgery during pregnancy and fetal outcome. Am J Obstet Gynecol. 1980;138:165-7.
6. Kort B, Katz VL, Watson WJ. The effect of nonobstetric operation during pregnancy. Surg Gynecol Obstet. 1993;177:371-6.
7. Naughton NN, Cohen SE. Nonobstetric surgery during pregnancy. En: Chestnut DH, editor. Obstetric anesthesia: Principles and practice. 3rd ed. Philadelphia: Elsevier Mosby; 2004. p. 255-72.
8. Crowhurst JA. Anaesthesia for non obstetric surgery during pregnancy. Acta Anaesthesiol Belg. 2002;53:295-7.
9. Cohen SE. Nonobstetric surgery during pregnancy. En: Chestnut DH, editor. Obstetric anesthesia: Principles and practice. 2nd ed. St. Louis: Elsevier Mosby; 1999. p. 279.
10. Kress HG. Effects of general anaesthetics on second messenger systems. Eur J Anaesthesiol. 1995;12:83-97.
11. Sturrock JE, Nunn JF. Mitosis in mammalian cells during exposure to anesthetics. Anesthesiology. 1975;43:21-33.
12. Wang LP, Paech MJ. Neuroanesthesia for the pregnant woman. Anesth Analg. 2008;107:193-200.
13. Kuczkowski KM. Nonobstetric surgery during pregnancy: What are the risks of anesthesia? Obstet Gynecol Surv. 2004;59:52-6.
14. Horrigan TJ, Villareal R, Weinstein L. Are obstetrical personnel required for intraoperative fetal monitoring during nonobstetric surgery? J Perinatol. 1999;19:124-6.
15. ACOG. ACOG Committee on Obstetric Practice. Nonobstetric surgery in pregnancy. Obstet Gynecol. 2003;102:431.
16. Dardon JC, Herrera L, Pérez A. Estudio comparativo, prospectivo, longitudinal y aleatorio de tres técnicas de bloqueos cervicobraquiales para cirugía de extremidades superiores. Rev Mex Anest. 2000;23:7-10.
17. Vásques MI, Jiménez AM, Aguirre OD, González MP, Ríos AM. Bloqueo supraclavicular bilateral con ecografía. Rev Colomb Anestesiol. 2012;40:304-8.
18. Ortega Romero A, de Diego Isasa D, del Olmo Rodríguez C, Maroto Ramos E, Rouco Gil R. Ecografía portátil en anestesia regional: bloqueos del plexo braquial. Rev Esp Anestesiol Reanim. 2008;55:294-303.
19. Wilson JL, Brown DL, Wong GY, Ehman RL, Cahill DR. Infraclavicular brachial plexus block: Parasagittal anatomy important to the coracoid technique. Anesth Analg. 1998;87:870-3.
20. Perlas A, Chan VW, Simons M. Brachial plexus examination and localization using and electrical stimulation. Anesthesiology. 2003;99:429-35.
21. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7-17.
22. Bigeleisen P. Nerve puncture and apparent intraneural injection during ultrasound-guided axillary block does not invariably result in neurologic injury. Anesthesiology. 2006;105:779-83.
23. Naughton NN, Chitra CS. Nonobstetric surgery during pregnancy. In: Chestnut DH, editor. Obstetric anesthesia: principles and practice. Philadelphia: Elsevier Mosby; 2004. p. 255-72.
How to Cite
1.
Guerrero-Domínguez R, López-Herrera-Rodríguez D, Fernández-López J, Luengo Ángeles, Jiménez I. Anaesthetic management for emergent upper limb trauma surgery in a 23-week pregnant woman: Role of ultrasound-guided infraclavicular brachial plexus block. Case report. Colomb. J. Anesthesiol. [Internet]. 2014 Jul. 1 [cited 2024 Apr. 26];42(3):234-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/710
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Published
2014-07-01
How to Cite
1.
Guerrero-Domínguez R, López-Herrera-Rodríguez D, Fernández-López J, Luengo Ángeles, Jiménez I. Anaesthetic management for emergent upper limb trauma surgery in a 23-week pregnant woman: Role of ultrasound-guided infraclavicular brachial plexus block. Case report. Colomb. J. Anesthesiol. [Internet]. 2014 Jul. 1 [cited 2024 Apr. 26];42(3):234-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/710
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Section
Case Report / Case Series
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