Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report.
Anaphylaxis
Basophil activation test
Cesarean delivery
Local anesthetic
Mepivacaine
Pregnancy
Spinal anesthesia
Journal
JA clinical reports
ISSN: 2363-9024
Titre abrégé: JA Clin Rep
Pays: Germany
ID NLM: 101682121
Informations de publication
Date de publication:
19 Dec 2019
19 Dec 2019
Historique:
received:
08
10
2019
accepted:
28
11
2019
entrez:
7
2
2020
pubmed:
7
2
2020
medline:
7
2
2020
Statut:
epublish
Résumé
Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother's vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued.
Sections du résumé
BACKGROUND
BACKGROUND
Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn.
CASE PRESENTATION
METHODS
A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother's vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis.
CONCLUSIONS
CONCLUSIONS
This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued.
Identifiants
pubmed: 32026066
doi: 10.1186/s40981-019-0302-6
pii: 10.1186/s40981-019-0302-6
pmc: PMC6967107
doi:
Types de publication
Journal Article
Langues
eng
Pagination
84Références
J Perinat Med. 2004;32(4):375-7
pubmed: 15346827
BJOG. 2018 Sep;125(10):1340-1341
pubmed: 29952063
Anesth Analg. 2018 May;126(5):1509-1516
pubmed: 29517573
J Allergy Clin Immunol Pract. 2019 Nov - Dec;7(8):2606-2612.e3
pubmed: 31102701
Obstet Gynecol. 2009 Jul;114(1):192-202
pubmed: 19546798
Ann Allergy Asthma Immunol. 2007 Sep;99(3):287-9
pubmed: 17910335
J Allergy Clin Immunol Pract. 2018 Sep - Oct;6(5):1681-1689
pubmed: 29477296
Br J Anaesth. 2004 Apr;92(4):459-61
pubmed: 15013956
Int J Obstet Anesth. 2013 Jul;22(3):231-42
pubmed: 23711758
Gynecol Obstet Invest. 2002;54(3):183-4
pubmed: 12571444
Int J Obstet Anesth. 2008 Oct;17(4):350-7
pubmed: 18691872
J Obstet Gynaecol. 2008 Oct;28(7):751-3
pubmed: 19065378
J Anesth. 2003;17(3):199-200
pubmed: 12911210
Br J Anaesth. 2018 Jul;121(1):172-188
pubmed: 29935569
Anesth Analg. 2013 Dec;117(6):1357-67
pubmed: 24257386
J Allergy Clin Immunol Pract. 2018 Jul - Aug;6(4):1176-1184
pubmed: 29454709
Br J Anaesth. 2019 Jul;123(1):e117-e125
pubmed: 30915999