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Neurally Mediated Syncope During Cesarean Delivery: A Case Report.

Seiko Sato1, Erisa Nakamori, Go Kusumoto

  • 1From the *Department of Anesthesiology, Fukuoka University Hospital, Fukuoka, Japan; and †Operating Rooms, Fukuoka University Hospital, Fukuoka, Japan.

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A pregnant patient experienced cardiac arrest during cesarean delivery due to a combination of medications and procedures. This case highlights the critical risks anesthesiologists must consider in high-risk pregnancies.

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Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Cardiology

Background:

  • Preeclampsia poses significant risks during pregnancy, including hypovolemia.
  • Cesarean delivery under regional anesthesia is a common procedure for preeclamptic patients.
  • Uterine relaxation and fundal pressure are sometimes employed during cesarean deliveries.

Observation:

  • A 28-year-old woman at 32 weeks gestation with preeclampsia underwent cesarean delivery under spinal anesthesia.
  • Nitroglycerin administration (200 μg) for uterine relaxation and fundal pressure application precipitated severe bradycardia, loss of consciousness, and cardiac arrest.
  • Immediate delivery and cardiopulmonary resuscitation resulted in recovery within 10 seconds.

Findings:

  • The cardiac arrest was likely caused by neurally mediated syncope.
  • The combination of nitroglycerin, fundal pressure, spinal anesthesia, and preeclampsia-related hypovolemia created a high-risk scenario.
  • This event underscores the potential for severe cardiovascular compromise during cesarean delivery.

Implications:

  • Anesthesiologists must exercise extreme caution when administering medications like nitroglycerin and applying fundal pressure during cesarean deliveries in preeclamptic patients.
  • Awareness of potential neurally mediated syncope is crucial in managing obstetric emergencies.
  • This case emphasizes the need for vigilant monitoring and preparedness for adverse cardiovascular events in high-risk pregnancies.