[An emergency cesarean section using general anesthesia for a patient with schizophrenia]

Area of Science:

• Anesthesiology
• Obstetrics
• Psychiatry

Background:

• Schizophrenia management during pregnancy presents unique challenges, especially when acute psychiatric episodes necessitate emergency surgical intervention.
• General anesthesia was chosen for an emergency Cesarean section due to the patient's severe agitation, precluding regional anesthesia techniques.

Observation:

• A 27-year-old pregnant patient at 39 weeks gestation with a history of schizophrenia experienced acute excitement and generalized muscle rigidity.
• Intramuscular levomepromazine and diazepam failed to adequately sedate the patient, necessitating an emergency Cesarean section under general anesthesia.

Findings:

• General anesthesia was successfully induced using thiopental and succinylcholine, with a 12-minute induction-delivery time.
• Plasma levomepromazine levels were measured in the mother (46.9 ng/mL) and umbilical vein (11.3 ng/mL).
• The neonate exhibited a good Apgar score but developed transient generalized tremor, likely due to maternal levomepromazine exposure.

Implications:

• This case highlights the complexities of anesthetic management in pregnant patients with psychiatric disorders requiring urgent Cesarean delivery.
• The findings suggest careful consideration of antipsychotic medication timing and potential neonatal effects when planning anesthesia for obstetric emergencies.
• Successful management underscores the importance of a multidisciplinary approach in managing high-risk obstetric patients.