Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section - a case report
Background and Aims: Uncontrolled hyperthyroid patient in pregnancy for emergency caesarean section under general anaesthesia managed by giving antithyroid agents, beta blockers, dexamethasone preoperatively to inhibit peripheral conversion of T4 to T3 and to control symptoms of hyperthyroidism. Cas...
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| Format: | Article |
| Language: | English |
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Sadra Danesh Negar
2023-08-01
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| Series: | Novelty in Clinical Medicine |
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| Online Access: | https://www.nclinmed.com/article_178363_06b23f239ebb04814c397d070deae8bd.pdf |
| _version_ | 1797327262549278720 |
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| author | Vasudha Govil Rashmi Rashmi Ritu Ritu Anju Rani Sudha Puhal Nikita Bajaj |
| author_facet | Vasudha Govil Rashmi Rashmi Ritu Ritu Anju Rani Sudha Puhal Nikita Bajaj |
| author_sort | Vasudha Govil |
| collection | DOAJ |
| description | Background and Aims: Uncontrolled hyperthyroid patient in pregnancy for emergency caesarean section under general anaesthesia managed by giving antithyroid agents, beta blockers, dexamethasone preoperatively to inhibit peripheral conversion of T4 to T3 and to control symptoms of hyperthyroidism.
Case presentation: A 20-year-old primigravida, presented at 37 weeks of gestation with complaints of respiratory difficulty, tremors, excessive sweating, prominent eyes, palpitations and anxiety. Patient was given oral propylthiouracil, lugol’s solution, tablet propranolol, injection dexamethasone and injection pantoprazole intravenous preoperatively. Nasogastric tube was inserted for further administration of antithyroid medications. Arterial blood pressure cannula secured and central venous cannulation done in case thyroid storm occurs which may require large volume resuscitation. Patient was managed successfully under general anaesthesia and monitored for thyroid storm in postoperative period.
Discussion: In patients with poorly controlled hyperthyroidism labour, delivery or caesarean section can precipitate life threatening thyroid storm. In case of thyroid storm antithyroid drugs can be administered orally or rectally so Ryle’s tube was inserted preoperatively. General anaesthesia should be considered in patients of uncontrolled hyperthyroidism requiring emergency surgery as it provides less fluctuations in hemodynamic parameters. Sympathetic stimulation should be avoided in perioperative period. Regional anaesthesia can be performed safely if there are no signs of cardiac failure. In the present case there were no signs of cardiac failure but the patient had tachypnoea so a decision to proceed with general anaesthesia with central venous catheterization and invasive blood pressure monitoring was made. |
| first_indexed | 2024-03-08T06:35:46Z |
| format | Article |
| id | doaj.art-d2bac813c8ab448096fa47d8062399a1 |
| institution | Directory Open Access Journal |
| issn | 2783-4492 |
| language | English |
| last_indexed | 2024-03-08T06:35:46Z |
| publishDate | 2023-08-01 |
| publisher | Sadra Danesh Negar |
| record_format | Article |
| series | Novelty in Clinical Medicine |
| spelling | doaj.art-d2bac813c8ab448096fa47d8062399a12024-02-03T10:15:42ZengSadra Danesh NegarNovelty in Clinical Medicine2783-44922023-08-012316316710.22034/ncm.2023.412332.1112178363Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section - a case reportVasudha Govil0Rashmi Rashmi1Ritu Ritu2Anju Rani3Sudha Puhal4Nikita Bajaj5Department of Anaesthesia and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, IndiaDepartment of Anaesthesia and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, IndiaDepartment of Anaesthesia, N C Medical College, Panipat, Haryana, IndiaDepartment of Anaesthesia and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, IndiaDepartment of Anaesthesia and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, IndiaDepartment of Anaesthesia and Critical Care, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, IndiaBackground and Aims: Uncontrolled hyperthyroid patient in pregnancy for emergency caesarean section under general anaesthesia managed by giving antithyroid agents, beta blockers, dexamethasone preoperatively to inhibit peripheral conversion of T4 to T3 and to control symptoms of hyperthyroidism. Case presentation: A 20-year-old primigravida, presented at 37 weeks of gestation with complaints of respiratory difficulty, tremors, excessive sweating, prominent eyes, palpitations and anxiety. Patient was given oral propylthiouracil, lugol’s solution, tablet propranolol, injection dexamethasone and injection pantoprazole intravenous preoperatively. Nasogastric tube was inserted for further administration of antithyroid medications. Arterial blood pressure cannula secured and central venous cannulation done in case thyroid storm occurs which may require large volume resuscitation. Patient was managed successfully under general anaesthesia and monitored for thyroid storm in postoperative period. Discussion: In patients with poorly controlled hyperthyroidism labour, delivery or caesarean section can precipitate life threatening thyroid storm. In case of thyroid storm antithyroid drugs can be administered orally or rectally so Ryle’s tube was inserted preoperatively. General anaesthesia should be considered in patients of uncontrolled hyperthyroidism requiring emergency surgery as it provides less fluctuations in hemodynamic parameters. Sympathetic stimulation should be avoided in perioperative period. Regional anaesthesia can be performed safely if there are no signs of cardiac failure. In the present case there were no signs of cardiac failure but the patient had tachypnoea so a decision to proceed with general anaesthesia with central venous catheterization and invasive blood pressure monitoring was made.https://www.nclinmed.com/article_178363_06b23f239ebb04814c397d070deae8bd.pdfcaesarean sectionemergencygeneral anaesthesiahyperthyroidismthyrotoxic storm |
| spellingShingle | Vasudha Govil Rashmi Rashmi Ritu Ritu Anju Rani Sudha Puhal Nikita Bajaj Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section - a case report Novelty in Clinical Medicine caesarean section emergency general anaesthesia hyperthyroidism thyrotoxic storm |
| title | Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section - a case report |
| title_full | Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section - a case report |
| title_fullStr | Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section - a case report |
| title_full_unstemmed | Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section - a case report |
| title_short | Anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section - a case report |
| title_sort | anesthetic management of a pregnant patient with uncontrolled hyperthyroidism for emergency caesarean section a case report |
| topic | caesarean section emergency general anaesthesia hyperthyroidism thyrotoxic storm |
| url | https://www.nclinmed.com/article_178363_06b23f239ebb04814c397d070deae8bd.pdf |
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