Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report

JA Clinical Reports

Kunihisa Hotta¹  Miyuki Takahashi¹  Mamoru Takeuchi¹  Takashi Igarashi¹  Tatsuo Horiuchi²  Soichiro Inoue³  Tomonori Takazawa⁴ 

[1] Department of Anesthesiology and Critical Care Medicine, Jichi Medical University;Department of Anesthesiology, Gunma University Graduate School of Medicine;Department of Anesthesiology, St. Marianna University School of Medicine;Intensive Care Unit, Gunma University Hospital;

关键词: Anaphylaxis;    Pregnancy;    Cesarean delivery;    Spinal anesthesia;    Local anesthetic;    Mepivacaine;   

DOI  :  10.1186/s40981-019-0302-6

来源: DOAJ

【 摘 要 】

Abstract Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued.

【 授权许可】

Unknown