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Pulmonary Oedema Case Study

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INTRODUCTION
Acute pulmonary oedema is a rare, but life-threatening problem which may cause significant morbidity and mortality in pregnant women. It may occur due to pathologies such as pre-eclampsia, sepsis, amniotic fluid embolism, fluid-overload or beta-adrenergic tocolytic drugs during the antenatal, intrapartum or postpartum periods. Moreover, pre-existing cardiopulmonary diseases may worsen due to the superimposed effects of physiological changes related to pregnancy (1). Management of these patients is a challenge for the anaesthesiologists, because there are no controlled studies or guidelines pointing out the best type of anaesthetic technique in these patients (2).
CASE
A 38 years old, pregnant patient with a history of rheumatic …show more content…

Cardiovascular stress related to pregnancy, labour and delivery may induce various degrees of cardiac failure in pregnants with cardiac diseases (2). A systolic pulmonary artery pressure of above 50 mmHg is associated with cardiac complications during pregnancy as functional status worsens more rapidly in pregnant patients with mitral valve stenosis. Cardiac decompensation and pulmonary oedema may occur at any time during the second or third trimester. Fluid restriction, diuretics, and control of atrial fibrillation are basic measures that can prevent pulmonary congestion (2). Safe use of NPPV and regional anaesthesia combination for caesarean section have previously described with several case reports in patients with respiratory failure due to kyphoscoliosis, neuromuscular diseases, acute respiratory distress syndrome, pneumonia and non-cardiogenic pulmonary oedema (3-5). In our patient, acute pulmonary oedema developed presumably because of tachycardia caused by anxiety and pain caused by preterm labour in our patient with pre-existing multivalvular heart disease and limited cardiac reserve. Management of these patients is difficult, because guidelines and standards are lacking. Some authors have described the use of general anaesthesia with good maternal outcome, whereas others have reported increased pulmonary arterial pressure during laryngoscopy and

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When Sibert was not responding the anaesthetist then allowed a slow inhalation of Isoflurane to be delivered to patient through the face mask. When the patient was fully anaesthetised the author assisted the anaesthetist to secure the airway by passing size 4 Laryngoscope and size 8 endotracheal tube (ETT). The ETT was cuffed and tightly secured. Sibert was then transferred to the operating table and monitoring continued. Anaesthesia was maintained with O2, Isoflurane, and N2O on spontaneous ventilation with closed circuit.

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Shah addresses the reader with caring motives and understanding of how physically demanding and life-changing pregnancy can be. ‘’I am acutely aware that even women with healthy pregnancies can develop life-threatening hemorrhage, fetal distress, or other unanticipated emergencies during labor.’’ Shah recognizes the risk associated with pregnancy and tells the reader of his concerns. He even recognizes the amount of financial expenses and stress associated with C-sections. ‘’Nearly, half of the of the caesareans we do in the US currently appear to be

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This causes elevated pulmonary capillary pressure which pushes fluid into the interstitial spaces and alveoli (Bickley & Szilagyi, 2013) 2) Dizziness is a concerning symptom as it may mean her pulmonary hypertension is worsening. Insufficient circulation of blood through the pulmonary capillaries can lead to hypoxemia in persons with respiratory or cardiac disease (Porth, 2011). I would have liked to know what this patient’s pulse oximetry was or if she

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The patient has a PMHx of diabetes type II, asthma and is morbidly obese. The patient denies any previous adverse outcomes post anesthesia and has come to the clinic today for a required medical clearance . Upon entering the room, the ARNP noticed the patient has a persistent cough, is short of breath

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The anaesthetist removed the ETT and proceeded to place a tight fitted mask on patients face. (REF)She then alerted the team that there was a problem with the patient airway (REF). The mask did not mist up – indicating of no air movement return, there was no carbon dioxide trace on the capnography and the patient oxygen saturation dropped steadily from 100% to 90%. He instigated vigorous jaw thrust to improve oxygenation, and using continuous positive airway pressure(CPAP) to deliver 100% oxygen flow through the breathing bag attached to the anaesthetic machine but all this effort was not having any effect on the ventilation. He then asked my mentor the Operating Department Practitioner (ODP) to administer 50mg/5ml of intravenous Propofol.

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