A CASE OF ANAPHYLAXIS IN POST OPERATIVE

CARE AFTER LSCS

DR. AKM SAIFUZZAMAN

SPECIALIST ANAESTHESIOGY
SHL
 INTRODUCTION

Mrs. Shamima Nasrin a 33 years old lady got admitted in

the department of gynae and obs in SHL on 23.10.22 at her
37 weeks of pregnancy (IVF) with cervical cerclage.

Her primary consultant was Dr. Rehnuma Jahan, Senior

Consultant of Gynae and obs.
 PRE ANESTHETIC CHECK UP:

PACU Date: 23.10.22

Date of Operation : 24.10.22
Pre operative Diagnosis: 37 weeks of gestation with Cervical Cerclage with Bronchial Asthma
Proposed Operation: LSCS with removal of cervical cerclage
Co Morbidities: Bronchial Asthma
Allergic History: Cold Allergy
Drug History: Tab. Montelukast 10mg
Surgical History:
1. Laparoscopy 2017 under GA (Uneventful)
2.Cervical Cerclage June 2022 under SAB (Uneventful)
 GENERAL EXAMINATION

Weight: 60 kg
BP: 110/80mmhg
HR: 78 b/min
Blood group: A+ve
SPO2: 98%
 INVESTIGATION PROFILE:

CBC: WCC: 18.9

Hb%: 12.1 gm/dl
Platelet count: 214
Blood glucose: 5.0mmol/l
C 19 RAT: Negative
 AIRWAY & SYSTEMIC EXAMINATION:

Thyromental distance >3 fingers

Mallampati score: II
No loose/artificial/missing teeth
CVS: S1+S2+0
Respiratory System: Breath sound : Vesicular , No Added sounds
GCS score: 15/15
No other systemic abnormality.
 PRE ANESTHETIC ADVICE

Patient was well counselled about anesthetic technique,

probable risk and reassurance was done.

Advised for Nebulization with Salbutamol before surgery and

continuing Tab. Montelukast. Also advised for arranging one unit
PRBC.
 PRE OPERATIVE EVENTS:

Anesthetic Plan: SAB

As patient were brought to OT and got up to OT table Monitoring
equipment were attached NIBP, ECG and Pulse oximeter.
IV line by 18 G Cannula were in situ Left hand and Hartman's Saline was
started.
B/P was around 127/68 and HR was 95 b/min
SPO2 : 99% in atmospheric air
 SAB TECHNIQUE:

Time: 10:50 AM
Drugs and Instruments Checked.
Patient Position: Sitting
Approach: Midline, L3-4
Needle: 25 G
Local infiltration: 2% Lidocaine 2 ml
Drug used: Bupivacaine 0.5% Heavy 2 ml with Fentanyl 20 mcg
Assessment of block: Complete
 PER OPERATIVE EVENTS:

Operation was started by Dr. Rehnuma Jahan, Cons Gynae &

Obs , After 3 min a healthy male baby was born @ 10:58 am . Inj.
Carbetocin 100mcg was given.

Maintenance fluid: Hartman's Solution.

 PER OPERATIVE MONITORING:

SPO2: 98-100% with O2 2l/min Nasal Prongs.

ECG: Normal Sinus Rhythm
HR: 90-110b/min
Surgery ended @ 11:30 am
Per operative Events: Uneventful.
After completion of surgery Patient was shifted to Post operative care.
 POST OPERATIVE EVENTS

After 30 min Anesthesiologist was called immediately to attend the patient in post operative ward
and code blue was called.
On examination patient was having:
Severe Restlessness
Oral Swelling
Bronchospasm
Frothy Secretion per oral
SPO2: falling around 80%
Peripheral Pulses were absent
Carotid Pulses : Feeble
BP: Not Recordable
 IMMEDIATE MX:

Called for help and Code blue was called.

Assessment of the scenario: Inj. Seclo (omeprazole) Was the cause of the
Anaphylaxis.
Fluid load with crystalloid.
100% O2 through venti mask.
Oro pharyngeal suction.
Head down leg up position.
Oropharyngeal Airway.
 CONTD…

Nebulization started with Salbutamol and Budicort.

Inj. Cotson 200mg stat given.
Inj. Adrenaline 1:1000 0.5ml(500mcg) IM given waited 3 min as
there was no improvement another 5 ml Inj Adrenaline 1:10000
(500mcg was given) IV
 CONTD.

Advised Continuous monitoring, Fluid management.

Investigations advised:
1. Trop I
2. CKMB
3. Echocardiography
Cardiology Consultation.
 After 3 hours patients vitals became stable and patient was shifted to
cabin.
Thank you all