RESUMEN
A young patient, primigravida with rheumatic heart disease, hypothyroidism and met-hemoglobinemia had central and peripheral cyanosis was scheduled for caesarean section under general anesthesia in two days. Author managed met-hemoglobinemia with ascorbic acid keeping methylene blue as standby. Haemoglobin saturation was 89% at room air and 92% with supplemental oxygen. Initial met-haemoglobin levels were 31.54% (normal values <1%). After optimizing thyroid and RHD status (moderate MR and mild MS), she was given tablet ascorbic acid 2 gram thrice a day with methylene blue as standby. Conventional balanced general anesthesia technique was used and she was followed up in postoperative period with ICU care. A healthy live female baby was extracted and mother had stable vital parameters. Postoperative treatment with ascorbic acid was continued. Repeated methaemoglobin levels showed a drop from preoperative value of 31.54% to 11.39% by 3rd postoperative day and 8.05% at the end of 1st week. At the time of discharge, she did not have any cyanosis. Ascorbic acid is a good alternative drug with limited experience in met-hemoglobinemia. Author present a case of a met-hemoglobinemia treated with ascorbic acid successfully to emphasize the use of ascorbic acid as an alternative method without any adverse effects.
RESUMEN
Traumatic brain injury in a pregnant woman is a challenge for anaesthesiologist, surgeon as well as paediatrician as it involves care and management of two lives together. We hereby discuss anaesthetic management of a 23 year old pregnant woman with extra axial bleed and brain contusion and skull fracture. Since the fetus was viable without signs of fetal distress, decision of doing caesarean section followed by craniotomy was taken and our patient was discharged a week later and the baby was handed over to attendant the next day.