Author(s)

E. O. Oyebamiji^1*, B. B. Osinaike¹, B. T. Olaifa¹, A. A. Adeniji²

¹Department of Anesthesia, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
²Department of Obstetrics & Gynecology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.

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 mortality 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 saddle). 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.

Severe Preeclampsia, Pulmonary Edema, Anesthetic Management, Poor Resource Setting

Oyebamiji, E. , Osinaike, B. , Olaifa, B. and Adeniji, A. (2015) Anesthetic Dilemma: Spinal Anesthesia in a Severe Pre-Eclamptic Patient with Twin Gestation, Heart Failure and Acute Pulmonary Edema. Open Journal of Obstetrics and Gynecology, 5, 208-212. doi: 10.4236/ojog.2015.54030.