Anaesthetic management of parturient patient with covid 19 for caesarean section

ABSTRACT

Background: In this pandemic of covid 19 Parturient patients are facing double problem of carrying foetus with lung involvement leading to hypoxia to both mother and baby. Case Report A young 31 years old lady, primi with 34 weeks pregnancy presented with 5 days history of covid 19 with acute SOB, fever, HRCT-Corad 6 and RTPCR +VE. Her SPO2 was 65%despite receiving oxygen @20L/mt. Looking to the hypoxemia to the patient and the foetus, the pulmonologist advised to terminate the pregnancy so that foetus can be saved and patient can be ventilated better. Looking to the lungs condition GA was avoided. Patient was given sub arachnoid block with 2.2ml bupivacaine 0.5% heavy. When she laid down, she developed dyspnoea (B.P. remained normal) for which she was given positive ventilation through mask. Her saturation remained 65% and respiratory rate 45. As soon as the baby was delivered, her saturation improved to 80% & and respiratory rate declined to 24. Patient stood surgery well and shifted back to ICU at SPO2 80%. The patient deteriorated later on with almost 95% lung involvement. Even after 50 days post surgery she is on oxygen support. Conclusion: The covid 19 has detrimental effects on Lung Parenchyma and conduction of anaesthesia in such morbid patients is always challenging. Choice of anaesthesia and selection of drugs is always tricky. A good outcome cannot always be guaranteed.