Anesthetic management in parturients with chronic kidney disease undergoing elective Caesarean delivery: Our experience of nine cases

Abstract

In this retrospective study, we describe the anesthetic management and its implications in parturients with chronic kidney disease (CKD; n = 9), who underwent elective caesarean delivery. Nine parturients with CKD of various etiologies, who underwent elective Caesarean delivery, were included in this study. Spinal anest-hesia was administered in all parturients with normal coagulation profile through a 25-gauze spinal needle (Quincke) with 0.5% (H) bupivacaine in L2-3 space and T6 level was achieved. Hemodynamics and side effects such as nausea, vomiting, headache, and backache were record. The mean age was 28.22 ± 4.43 years. The mean levels of serum creatinine and serum potassium were 2.78 ± 1.29 mg/dl and 4.11 ± 0.46 meq/l, respectively. Mean baseline values of systolic blood pressure, diastolic blood pressure, and pulse rate were higher which decreased after spinal anesthesia. However, the incidence of hypotension, which required mephentermine treatment, was 11.1%. One patient had symptoms of nausea and vomiting/dizziness at the time of hypotension, which disappeared after treatment with 5 mg of intravenous mephentermine. Baseline value of PR remained high throughout the operation. Parturients with CKD with normal coagulation profile remained hemodynamically stable under spinal anesthesia with minimal side effects. However, a large number of studies are required to determine the safety of spinal anesthesia in this setting.

Case Report: Anesthesia for Cesarean Section in Parturients With Chronic Renal Failure Requiring Hemodialysis: Case Reports and Literature Review

“…For patients undergoing cesarean section with HD, the choice of anesthetic methods and intraoperative management are very important. The primary task of the selection of anesthetic methods for such patients is to ensure the safety of the mother and the fetus, to minimize the adverse effects of pregnancy and kidney disease on mother and consequent effects on the fetus, and to avoid aggravating the renal failure of patients ( 13 ). Patients with CRF have a high risk of anesthesia, to help choose the appropriate anesthetic technique for such patients, a literature search of published case reports of pregnancy associated with CRF requiring HD was performed and listed in Table 3 .…”

“…In addition, decreased gastric motility and delayed gastric emptying in parturients may increase the risk of aspiration during general anesthesia ( 11 , 19 ). When general anesthesia is performed on patients with CKD, it is necessary to consider the effects of an altered clearance, the production and accumulation of active metabolites, and the risk of aggravating pre-existing kidney disease on drug administration ( 13 ). In addition, these neonates often have intrauterine growth retardation, low birth weight and premature delivery are prone to the adverse effects of anesthetic agents ( 13 ).…”

“…When general anesthesia is performed on patients with CKD, it is necessary to consider the effects of an altered clearance, the production and accumulation of active metabolites, and the risk of aggravating pre-existing kidney disease on drug administration ( 13 ). In addition, these neonates often have intrauterine growth retardation, low birth weight and premature delivery are prone to the adverse effects of anesthetic agents ( 13 ). Due to the rapid and predictable effects of general anesthesia, the majority being performed for lack of time in the setting of an emergency delivery such as severe fetal distress, or in cases of failure or contraindications of intrathecal anesthesia ( 20 ).…”

“…In cesarean delivery, regional anesthesia using spinal or epidural anesthesia is a safe technique to minimize the risk of fetal depression and aspiration pneumonia in the mother ( 13 ). Compared with general anesthesia, it is possible for regional anesthesia to establish a connection between the mother and newborn immediately after delivery.…”

Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist

“…Although uncommon, pregnancy has been reported in women undergoing hemodialysis [ 71 ]. Anticoagulation with heparin, thrombocytopenia and platelet dysfunction pose an increased bleeding risk during delivery and may preclude neuraxial anesthesia in end-stage-renal disease patients [ 70 ] Patients who are receiving adequate dialysis are less likely to have significant platelet dysfunction and their risk of bleeding is less [ 72 ]. Patients may also be hyper- or hypovolemic at the time of delivery due to the timing of dialysis.…”