perioperative management of a parturient with prior h o pulmonary embolism and ivc filter in situ n.
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PERIOPERATIVE MANAGEMENT OF A PARTURIENT WITH PRIOR H/O PULMONARY EMBOLISM AND IVC FILTER IN SITU

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PERIOPERATIVE MANAGEMENT OF A PARTURIENT WITH PRIOR H/O PULMONARY EMBOLISM AND IVC FILTER IN SITU. DR.KRANAPPU SOLOMON,DNB PG DR.RENU DEVAPRASATH,DNB (Anesth) DR.V.SANKARASUBRAMANIAN,M.D.(Anesth) DR.JEYASEKHARAN HOSPITAL &NURSING HOME, NAGERCOIL. CASE SCENARIO.

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perioperative management of a parturient with prior h o pulmonary embolism and ivc filter in situ

PERIOPERATIVE MANAGEMENT OF A PARTURIENT WITH PRIOR H/O PULMONARY EMBOLISM AND IVC FILTER IN SITU

DR.KRANAPPU SOLOMON,DNB PG

DR.RENU DEVAPRASATH,DNB (Anesth)

DR.V.SANKARASUBRAMANIAN,M.D.(Anesth)

DR.JEYASEKHARAN HOSPITAL &NURSING HOME, NAGERCOIL

case scenario
CASE SCENARIO
  • 21 year old primi came to our hospital at 7th month of gestation for antenatal checkup.
  • Gave past h/o superior sagittal sinus thrombosis 4 years back.
  • Mild antithrombin III deficiency & was on tab.Warfarin
  • H/o iliofemoral deep venous thrombosis extending into IVC upto renal veins level.
  • H/o pulmonary embolism, thrombolysed and prophylactic permanent transjugular IVC filter deployed prior to discharge with oral anticoagulants.
antenatal scenario
ANTENATAL SCENARIO
  • As soon as pregnancy was confirmed warfarin was stopped,started on inj.fondaparinux 2.5mg OD sc as per physician advice.
  • Antenatal checkup continued in our hospital.
  • Advised to get admitted 3days prior to anticipated time of delivery.
preoperative preparation
PREOPERATIVE PREPARATION
  • Coagulation workup done
  • Adequate fresh blood & fresh frozen plasma arranged
  • Inj.Fondaparinux stopped 48 hours prior to elective LSCS.
  • Risk of maternal haemorrhage & recurrent DVT/ PE in the postop. period explained.
  • Discussed with Obstetrician.
anesthetic management
ANESTHETIC MANAGEMENT
  • Two peripheral IV lines secured
  • Informed consent obtained for regional anaesthesia
  • SUBARACHNOID BLOCK
      • sitting position,
      • L3-4 level
      • 27G Quincke needle
      • Single shot
      • Drug: 0.5% Bupivacaine 2ml + 0.1mg morphine
  • Intraop-uneventful
      • Full term baby delivered
postop management
POSTOP.MANAGEMENT
  • Analgesia lasted for 20 hours.
  • Inj.Fondaparinux started after 24 hours.
  • Tab.Warfarin restarted.
  • PT,INR checked & maintained around 2.5-3.5
  • Patient had an uneventful postop. & discharged home.
discussion
DISCUSSION

Be prepared to take the new role

as perioperative physician.

Update on new drugs essential

-FONDAPARINUX.

Patient on anticoagulants: plan

early to avoid mishaps.

Pregnancy:high risk of DVT/PE

IVC Filter.

Anaesthetic technique of choice –

choose the best technique that

suits the patient and of course you.

answers for the anticipated problems
ANSWERS FOR THE ANTICIPATED PROBLEMS
  • Maternal bleeding.
  • Emergency caesarean.
  • Recurrent DVT/PE.
  • Dislodgement of IVC filter?
  • Anaesthesiology Clinics .vol.26,pg.1-22
  • Anaesthesiology Clinics of North America. vol.21,pg.99,165
  • Evidence-Based Practice Of Anesthesiology. Lee A.Fleisher ,pg.218.