Thoracic spinal anesthesia for cesarean section in severe pre-eclampsia: exploring a new dimension

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Abstract

Background
Severe pre-eclampsia poses a dilemma for the anesthesiologist especially in emergency situations where cesarean deliveries are done for the un-investigated or partially investigated parturient. Hemodynamic stability is the major goal of anesthetic management of these patients. Thoracic spinal anesthesia has been successfully given for various surgeries like breast cancer and abdominal cancer but not for cesarean section.
Case presentation
We report a case of a 35-year-old at 33-week period of gestation with severe pre-eclampsia and bullous lesions managed successfully with segmental thoracic spinal anesthesia. General anesthesia in this patient could have been risky as the patient was not fasting; airway bullous lesions could not be ruled out and Mallampati grade was III on airway examination. Presence of lesions in lumbar region precluded the lumbar spinal technique. The technique was associated with an adequate level of the sensory block during lower segment cesarean section, a high degree of hemodynamic stability, and a high patient satisfaction
Conclusion
Segmental thoracic spinal anesthesia can be used successfully and effectively for lower segment cesarean section by experienced anesthetists. Further studies are warranted to compare its effect, especially on hemodynamics with known techniques.

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