Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report

Abstract

Background: Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation: A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother's vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions: This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued.

Successful Management of a Suspected Case of Meperidine-Induced Anaphylaxis in Cesarean Delivery

“…The American College of Obstetricians and Gynecologists indicates that when anaphylaxis occurs, maternal stability does not guarantee fetal oxygenation. Previous case reports about anaphylaxis in pregnant women demonstrated that 46% of neonates were affected by neurologic adverse effects (12). In this case, both mother and neonate were discharged in healthy conditions.…”

“…Sripriya et al (10) reported an anaphylaxis reaction due to ranitidine during CS. Takahashi et al (12) reported a case of cesarean delivery under combined spinal-epidural anesthesia that was affected by severe anaphylaxis reaction induced by bupivacaine. In their study, delivery was done after 18 minutes, so the first minute Apgar score was 2, and the neonate was intubated.…”

“…Some precautions are considered about epinephrine administration in pregnancy, including fetus hypoxic damage due to uterine vasoconstriction, pulmonary edema, and ventricular arrhythmia (9). Takahashi et al (12) used epinephrine, but it could not justify the neonate's poor condition. We also tried this drug because of no response to ephedrine, deterioration of the patient's condition, and the assurance of immediate delivery.…”

Distinguishing cerebrospinal fluid from mepivacaine using the pH test in patients undergoing elective cesarean section with combined spinal-epidural anesthesia

“…In addition, mepivacaine was used for both local infiltration and LOR in the present study. A case of mepivacaine-induced anaphylactic shock has recently been reported [ 11 ]. Therefore, the use of mepivacaine has a potential risk of an allergic reaction.…”

Drug-induced anaphylaxis during general anesthesia in 14 tertiary hospitals in Japan: a retrospective, multicenter, observational study

“…The study was registered with the University Hospital Medical Information Network Clinical Trials Registry (ID: 000022365). Some of the cases included in this study have already been presented in our previous reports, which had different perspectives from the present study [ 10 – 14 ].…”