General Anesthesia for the Gravid Patient in the Emergency Operating Room at Sanglah General Hospital

Abstract

General anesthesia and regional anesthesia are the anesthetic techniques of choice for caesarian delivery. Anesthetic technique of choice is determined by several factors such as the safety of the parturient (evaluation of the airway and risk of aspiration), technical problems, the wellbeing of the fetus, and the experience of the anesthesiologist. Superiomposed preeclampsia is defined as chronic hypertension in pregnant women with gestational age > 20 weeks. When neurological manifestations arises, this condition becomes an emergency and requires immediate pregnancy termination by caesarian section. We report a case of a 42-year-old woman, 38-39 weeks pregnant, with a history of hypertension and ADHF Profile B, in an intubated state has undergone a green code caesarean section with general anesthesia using propofol 200 mg, fentanyl 100 mcg, rocuronium 50 mg. The operation lasted 50 minutes, and the patient maintained stable hemodynamics, with 300 ml blood loss. The baby was a male, born with APGAR score of 8/9, weighted 2410g. The patient was observed in the intensive care unit post-operatively. Pregnancy with superimposed preeclampsia carries a high risk of morbidity and mortality, for both the parturient and the fetus. Caesarean section with general anesthesia is preferred in superimposed preeclampsia with neurologic complications because it can achieve rapid induction, optimal airway control, and lower risk of hypotension and cardiovascular instability.