Question

A 29-year-old female patient who is 8-months pregnant is having an emergency appendectomy. She will have to receive general anesthesia for the procedure.

1. What anatomical changes have taken place in the patient that must be taken into account for this case?

2. How might the patient’s laboratory tests be changed by her being pregnant?

3. What additional emergency procedure should the CST be prepared to quickly set up and assist the surgeon?

4. What postoperative symptoms should be closely monitored that might indicate preterm labor?

5. What physiological occurrence is difficult to recognize in the pregnant patient and may result in the fetus becoming hypoxic? What device should be used both intraoperatively and postoperatively to avoid the complication?

Answer 1

The anatomical changes to be taken into account for anesthesia for appendicectomy is:

Acute appendicitis is a condition which can be performed under local anesthesia, regional anesthesia or general anesthesia. As in this patient there is 8 months pregnancy general anesthesia is better not prefered. So if regional anesthesia is given that is spinal anesthesia, the anatomical factor which has to be taken into account is, due to gravid uterus there is pressing on the vertebra and hence the spinal cord, the CSF is under higher pressure. so less amount of anesthetic agent will be required to be injected. Another anatomical consideration will be high blood volume of the patient and hence the risk of hypotension due to spinal anesthesia will be higher in pregnant woman. The third consideration will be the elevated level of diaphragm due to gravid uterus which can cause respiratory distress for the mother while lying down during surgery. If local Anesthesia is used, the spinal cord factor will not be present but more amount of anesthetic will be required for local infiltration as pregnancy is a high output state and the injected anesthetic can be washed out easily.

Laboratory value in acute appendicitis mostly is leucocytosis due to increased neutrophils, and the rest is non specific or normal. So if the woman is pregnant and has an acute appendicitis, there will be less leucocytosis because of increase in blood volume and the increase is more due to increased plasma. The other laboratory values will be similar to that of a normal pregnant woman and nothing more specific.