Incidental Hypoglycemia with Suspected High Spinal in a Case for Emergency Caesarian

Abstract

A 25-year-old primigravida with 39 wk gestation of height 152 cms weighing 55 kgs was posted for LSCS in view of Cephalo pelvic disproportion (CPD). She was nil by mouth for 10 h. On physical examination patient was moderately built and nourished, pale with alopecia and buck tooth. Patient gives history of fever in childhood at the age of 10 y with loss of hair. Examination of respiratory, cardiovascular and central nervous system revealed no abnormalities, including Investigations (Her blood sugars were normal).After taking informed consent, Spinal anaesthesia was planned for this patient. Monitors were connected and baseline vitals recorded. Spinal anaesthesia was induced with 2ml (10 mg) hyperbaric bupivacaine 0.5% with a 25 G spinal needle in L2-L3 interspace in sitting position. A wedge was given to right buttock and 10 degree head up was given. Sensory and motor block was adequate for surgery. Within 5 min patient became drowsy not responding to oral commands associated with sweating. As the patient was not responding, high spinal was suspected. Oxygen was administered with assisted ventilation. As it was an emergency LSCS surgery was continued with 100% oxygen throughout the surgical period. Baby extracted after 9 mins cried immediately after birth. Surgery was uneventful with no intraoperative hypotension or bradycardia. Patient was still drowsy, not responding to oral commands after closure of abdomen, after 50 min of Spinal anaesthesia and the level could not be assessed. As the patient had a episode of preoperative hypoglycemia, blood glucose level was checked and it was found to be 50mg/dl. Fifty ml of 25% Dextrose was infused after which the patient started responding to oral commands. There were no further episodes of hypoglycemia postoperatively. DisCussionHigh or complete spinal block is a known complication of spinal anesthesia. Pregnant women demonstrate increased sensitivity to both regional and general anesthetics. From early stages when neuraxial anesthesia is administered, pregnant women require less local anesthetic than non-pregnant women do to reach a given dermatomal sensory level [1].As high spinal is common in parturients, when the patient became unresponsive she was managed as a case of high spinal with 100% aBstRaCt Spinal anaesthesia is a suitable choice for emergency LSCS (lower segment caesarian section). High spinal is common in parturients. We report a case of 25-year-old primigravida with cephalo pelvic disproportion coming for emergency LSCS with no comorbidities. The patient became unresponsive after 5 min of Sub Arachnoid Block (SAB), managed as a case of high spinal. Still the patient remained unresponsive at the end of surgery, 50 min after SAB. Patient started responding to oral commands after correction of hypoglycemia with 25% dextrose infusion.Keywords: Anaesthesia, High sub arachnoid block, Low blood sugars, Pregnancy oxygen supplementation with assisted ventilation. As she remained unresponsive after the end of surgery other reasons were sought for her unresponsiven...

Hypoglycemia as a cause of sudden cardiac arrest during cesarean delivery under spinal anesthesia: a case report and review of the literature

“…The causes of sudden cardiac arrest during spinal anesthesia are related to anesthetic procedures, surgical procedures, hypotension, primary cardiac problems, massive pulmonary embolism, hypoglycemia, pathophysiological changes during pregnancy, and other related factors [1][2][3][4][5][6][7][8][9][10]. Here, we tried to consider these as the possible differential diagnosis.…”

“…Hypotension is among the leading causes of cardiac arrest [3]. Pregnant patients are more susceptible to hypotension, with incidences ranging from 50% to 90% [1].…”

“…During cesarean delivery, the major risk factors of hypotension are inadequate preloading, excessive intraoperative bleeding, inappropriate patient positioning, large-sized baby, maternal obesity, and anesthesia-related factors [1,3,5].…”

“…It is often difficult to determine whether surgical, anesthesia, or patient factors are the most significant factors leading to cardiac arrest [1,2]. The possible factors that may cause cardiac arrest during spinal anesthesia in a case of cesarean section are related to the anesthetic procedure, perioperative significant blood loss, amniotic fluid embolism, metabolic disorders, and/or pathophysiological changes in the obstetric patient [1][2][3][4].…”