Safety and efficacy of remifentanil target-controlled infusion for conscious sedation in a pregnant woman: a case report.
Analgosedation
Conscious sedation
FESS
Functional endoscopic sinus surgery
Pregnancy
Remifentanil
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
07 Mar 2024
07 Mar 2024
Historique:
received:
27
07
2023
accepted:
05
12
2023
medline:
8
3
2024
pubmed:
8
3
2024
entrez:
8
3
2024
Statut:
epublish
Résumé
Every year 2% of pregnant women undergo nonobstetric surgical interventions worldwide. According to the American College of Obstetricians and Gynecologists Committee on Obstetric Practice, pregnant women should never be denied the most appropriate surgical treatment, regardless of the trimester of pregnancy. However, additional attention should be paid during the first trimester since it has the highest risk of inducing teratogenic mutations; additionally, during the third trimester, due to the possibility of preterm birth and low birth weight of the newborn, great care should be paid. We present the case of a Caucasian 36-year-old woman during her 21st week of pregnancy, with a normal-sized fetus, according to the gestational age on ultrasound exam, and with no additional risk factors. The patient referred to an increasing nasal obstruction associated with rhinorrhea of the left nasal cavity. She also reported episodes of sleep apnea and hyposmia. The patient received a detailed otolaryngological examination, which allowed for identification of a mass within the left nasal cavity. The subsequent nasal endoscopy confirmed a grayish polypoid mass lesion with a multinodular surface occupying the entire left nasal fossa. The lesion totally obliterated the left maxillary sinus, resulting in obstruction of the anterior osteomeatal unit and ethmoidal sinusitis. She was referred for a functional endoscopic sinus surgery using analgosedation with remifentanil target-controlled infusion. To the very best of our knowledge, this is the first case described in English literature about the use of analgosedation with remifentanil target-controlled infusion for otolaryngology surgery, specifically in functional endoscopic sinus surgery. It could be an interesting option to avoid the use of inhaled anesthetics that could induce fetal damage, especially during the first months of pregnancy. Furthermore, patient intubation is not necessary, which avoids cases of difficult intubation or any trauma to the airways. An adequate informed consent and appropriate compliance are elements of paramount importance in tailoring the anesthetic strategy for pregnant women who need nonobstetric surgical management.
Sections du résumé
BACKGROUND
BACKGROUND
Every year 2% of pregnant women undergo nonobstetric surgical interventions worldwide. According to the American College of Obstetricians and Gynecologists Committee on Obstetric Practice, pregnant women should never be denied the most appropriate surgical treatment, regardless of the trimester of pregnancy. However, additional attention should be paid during the first trimester since it has the highest risk of inducing teratogenic mutations; additionally, during the third trimester, due to the possibility of preterm birth and low birth weight of the newborn, great care should be paid.
CASE PRESENTATION
METHODS
We present the case of a Caucasian 36-year-old woman during her 21st week of pregnancy, with a normal-sized fetus, according to the gestational age on ultrasound exam, and with no additional risk factors. The patient referred to an increasing nasal obstruction associated with rhinorrhea of the left nasal cavity. She also reported episodes of sleep apnea and hyposmia. The patient received a detailed otolaryngological examination, which allowed for identification of a mass within the left nasal cavity. The subsequent nasal endoscopy confirmed a grayish polypoid mass lesion with a multinodular surface occupying the entire left nasal fossa. The lesion totally obliterated the left maxillary sinus, resulting in obstruction of the anterior osteomeatal unit and ethmoidal sinusitis. She was referred for a functional endoscopic sinus surgery using analgosedation with remifentanil target-controlled infusion.
DISCUSSION AND CONCLUSION
CONCLUSIONS
To the very best of our knowledge, this is the first case described in English literature about the use of analgosedation with remifentanil target-controlled infusion for otolaryngology surgery, specifically in functional endoscopic sinus surgery. It could be an interesting option to avoid the use of inhaled anesthetics that could induce fetal damage, especially during the first months of pregnancy. Furthermore, patient intubation is not necessary, which avoids cases of difficult intubation or any trauma to the airways. An adequate informed consent and appropriate compliance are elements of paramount importance in tailoring the anesthetic strategy for pregnant women who need nonobstetric surgical management.
Identifiants
pubmed: 38454441
doi: 10.1186/s13256-023-04303-3
pii: 10.1186/s13256-023-04303-3
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
143Informations de copyright
© 2024. The Author(s).
Références
Balinskaite V, Bottle A, Sodhi V, Rivers A, Bennett PR, Brett SJ, et al. The risk of adverse pregnancy outcomes following nonobstetric surgery during pregnancy: estimates from a retrospective cohort study of 6.5 million pregnancies. Ann Surg. 2017;266(2):260–6.
doi: 10.1097/SLA.0000000000001976
Van De Velde M, De Buck F. Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol. 2007;73(4):235–40.
ACOG Committee Opinion No. 775: nonobstetric surgery during pregnancy. Obstet Gynecol. 2019;133(4):e285-e286
Cho S, Chung RK, Jin SH. Factors affecting maternal and fetal outcomes of non-obstetric surgery and anesthesia during pregnancy: a retrospective review of data at a single Tertiary University Hospital. J Korean Med Sci. 2020;35(16): e113.
doi: 10.3346/jkms.2020.35.e113
Li X, Wu Z, Zhang Y, Xu Y, Han G, Zhao P. Activation of autophagy contributes to sevoflurane-induced neurotoxicity in fetal rats. Front Mol Neurosci. 2017;10:432.
doi: 10.3389/fnmol.2017.00432
Hirotsu A, Iwata Y, Tatsumi K, Miyai Y, Matsuyama T, Tanaka T. Maternal exposure to volatile anesthetics induces IL-6 in fetal brains and affects neuronal development. Eur J Pharmacol. 2019;863: 172682.
doi: 10.1016/j.ejphar.2019.172682
Kan RE, Hughes SC, Rosen MA, Kessin C, Preston PG, Lobo EP. Intravenous remifentanil: placental transfer, maternal and neonatal effects. Anesthesiology. 1998;88(6):1467–74.
doi: 10.1097/00000542-199806000-00008
Marsh BJ, Sinskey J, Whitlock EL, Ferschl MB, Rollins MD. Use of remifentanil for open in utero fetal myelomeningocele repair maintains uterine relaxation with reduced volatile anesthetic concentration. Fetal Diagn Ther. 2020;47(11):810–6.
doi: 10.1159/000509384
Ragab SM, Hassanin MZ. Optimizing the surgical field in pediatric functional endoscopic sinus surgery: a new evidence-based approach. Otolaryngol Head Neck Surg. 2010;142(1):48–54.
doi: 10.1016/j.otohns.2009.10.021
Hamed MA. Comparative study between magnesium sulfate and lidocaine for controlled hypotension during functional endoscopic sinus surgery: a randomized controlled study. Anesth Essays Res. 2018;12(3):715–8.
doi: 10.4103/aer.AER_103_18
Neuman G, Koren G. Safety of procedural sedation in pregnancy. J Obstet Gynaecol Can. 2013;35(2):168–73.
doi: 10.1016/S1701-2163(15)31023-9
Bonnet MP. Sedation and anaesthesia for non-obstetric surgery. Anaesth Crit Care Pain Med. 2016;35(Suppl 1):S35–41.
doi: 10.1016/j.accpm.2016.06.009
Peeler CE, Villani CM, Fiorello MG, Lee HJ, Subramanian ML. Oral versus Intravenous Sedation Study Group. Patient satisfaction with oral versus intravenous sedation for cataract surgery: a randomized clinical trial. Ophthalmology. 2019;126(9):1212–8.
doi: 10.1016/j.ophtha.2019.04.022
Flanagan D. Oral triazolam sedation in implant dentistry. J Oral Implantol. 2004;30(2):93–7.
doi: 10.1563/1548-1336(2004)30<93:OTSIID>2.0.CO;2
London NR Jr, Reh DD. Differential diagnosis of chronic rhinosinusitis with nasal polyps. Adv Otorhinolaryngol. 2016;79:1–12.
Marangoni F, Cetin I, Verduci E, Canzone G, Giovannini M, Scollo P, et al. Maternal diet and nutrient requirements in pregnancy and breastfeeding. An Italian Consensus Document. Nutrients. 2016;8(10):629.
doi: 10.3390/nu8100629
Soares MJ, Iqbal K, Kozai K. Hypoxia and placental development. Birth Defects Res. 2017;109(17):1309–29.
doi: 10.1002/bdr2.1135
Rocke DA, Murray WB, Rout CC, Gouws E. Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia. Anesthesiology. 1992;77(1):67–73.
doi: 10.1097/00000542-199207000-00010
Pilkington S, Carli F, Dakin MJ, Romney M, De Witt KA, Doré CJ, et al. Increase in Mallampati score during pregnancy. Br J Anaesth. 1995;74(6):638–42.
doi: 10.1093/bja/74.6.638
Le Guevelou J, Lebars S, Kammerer E, de Gabory L, Vergez S, Janot F, et al. Head and neck cancer during pregnancy. Head Neck. 2019;41(10):3719–32.
doi: 10.1002/hed.25877
Powell H, Murphy VE, Hensley MJ, Giles W, Clifton VL, Gibson PG. Rhinitis in pregnant women with asthma is associated with poorer asthma control and quality of life. J Asthma. 2015;52(10):1023–30.
doi: 10.3109/02770903.2015.1054403
Yoruk O, Ucuncu H, Gursan N, Aktan B, Sutbeyaz Y, Altas E, et al. Sinonasal Burkitt lymphoma presenting as a nasal polyposis in a pregnant woman. J Craniofac Surg. 2009;20(4):1059–60.
doi: 10.1097/SCS.0b013e3181abb2ba
Derber C, Elam K, Bearman G. Invasive sinonasal disease due to dematiaceous fungi in immunocompromised individuals: case report and review of the literature. Int J Infect Dis. 2010;14(Suppl 3):e329–32.
doi: 10.1016/j.ijid.2010.04.003
Weber RK, Hosemann W. Comprehensive review on endonasal endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015;14:Doc08.
Sieśkiewicz A, Reszeć J, Piszczatowski B, Olszewska E, Klimiuk PA, Chyczewski L, et al. Intraoperative bleeding during endoscopic sinus surgery and microvascular density of the nasal mucosa. Adv Med Sci. 2014;59(1):132–5.
doi: 10.1016/j.advms.2013.10.001
Parvizi A, Haddadi S, Faghih Habibi A, Nemati S, Akhtar N, Ramezani H. Dexmedetomidine efficacy in quality of surgical field during endoscopic sinus surgery. Iran J Otorhinolaryngol. 2019;31(106):281–8.