Anesthetic Dilemma: Spinal Anesthesia in a Severe Pre-Eclamptic Patient with Twin Gestation, Heart Failure and Acute Pulmonary Edema

Abstract

Background: Severe preeclampsia with acute pulmonary oedema possesses great challenges to the anaesthetist. If not well managed, it could be associated with high maternal morbidity and mortal-ity rate as well as fetal wastage. Aim: To sensitize the anaesthetist that when confronted with such a dilemma, well managed low spinal block can be a useful and successful anaesthetic technique. Methods: We report the case of a 23-year-old primigravida with twins gestation at 36 weeks, who presented with severe ante-partum pre-eclapsia, acute pulmonary oedema and acute heart failure. Blood investigations done were normal, and clotting time was within normal range. Her clinical conditions were optimized through a well thoughtful medication after which a low dose spinal anesthesia was performed using 1.5 mls (7.5 mg) of 0.5% hyperbaric bupivacaine (Modified sad-dle). The baby was delivered through a low segment caesarean section. Conclusion: The procedure was well tolerated and successful. Low spinal is associated with low incidence of hypotension and do not require pre-loading.