Laparoscopic Appendicectomy in a 26-Weeks Parturient.

ABSTRACT

One of the commonest non-obstetric problem that will require surgical intervention during pregnancy is acute appendicitis. Laparoscopic appendectomy in parturient has many challenges to anesthesiologists like preterm labour, foetal morbidity, and maternal morbidity. Providing safe anaesthesia is such cases is challenging and necessary. The anaesthesiologist has to ensure maintenance of maternal oxygenation, perfusion, and homeostasis, with the least extensive anaesthetic for the best outcome for the foetus.Laparoscopy in pregnancy is challenging both for the surgeon and anaesthesiologist. Challenges faced by the anaesthesiologist includes laryngoscopy and tracheal intubation associated pressor responses haemodynamic changes associated with gravid uterus causing aortocaval compression and increased in intraabdominal pressures due to pneumoperitoneum, maternal CO2 monitoring to avoid maternal and foetal acidosis, considerations of avoiding foetal exposure to unnecessary medications & foetal heart rate monitoring. Whenever practically feasible regional anaesthesia is usually preferred over general anaesthesia in pregnancy whenever it is practically feasible. Regional anaesthesia in this case involves discomfort to the patient, need to take a higher level for surgical anaesthesia, hemodynamic changes associated after induction, risk of uterus manipulation by surgeons all of which can predispose to preterm labour. In our case we have opted for general anaesthesia over regional anesthesia due to fore mentioned reasons.