Case Report
Non-invasive mechanical ventilation with spinal anesthesia for cesarean delivery

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Abstract

We present the successful use of perioperative non-invasive mechanical ventilation in a morbidly obese pregnant woman with bronchial asthma, severe preeclampsia and pulmonary edema undergoing an emergency cesarean delivery with spinal anesthesia. The combination of non-invasive mechanical ventilation with neuraxial anesthesia may be of value in selected parturients with acute or chronic respiratory insufficiency requiring surgery.

Introduction

Preeclampsia and eclampsia are among the most common causes of maternal mortality and peripartum intensive care unit (ICU) admission worldwide.1 Pulmonary edema and respiratory insufficiency may result from preeclampsia and its treatment.1 Non-invasive mechanical ventilation (NIMV) is a commonly accepted treatment for chronic and acute respiratory insufficiency,2 and is an effective tool in promoting oxygenation pre- and postoperatively.2, 3 Only a limited number of cases and studies have reported its intraoperative use.2, 4, 5

We present the case of a morbidly obese pregnant woman with respiratory distress and pulmonary edema secondary to severe preeclampsia and bronchial asthma who was managed with spinal anesthesia and perioperative NIMV for emergency cesarean delivery.

Section snippets

Case report

A 28-year-old morbidly obese (BMI 41.5 kg m−2) primparous woman at 34 weeks of gestation presented to our emergency room (ER) with dyspnea and orthopnea. She reported a 10-year history of bronchial asthma for which she had been receiving irregular treatment; she was currently taking budesonide and formoterol fumarate by inhalation prescribed just one month previously. Due to unresolving respiratory symptoms, she visited another clinic, where she was diagnosed with severe preeclampsia. She was

Discussion

This case illustrates the successful use of NIMV (BiPAP) in a morbidly obese pregnant woman with respiratory distress secondary to severe preeclampsia and asthma undergoing emergency cesarean delivery with spinal anesthesia. The use of spinal anesthesia was selected due to concerns regarding difficult intubation, increased risk of aspiration, and perioperative pulmonary dysfunction further complicated by morbid obesity and pregnancy.6, 7 However, we were aware that neuraxial anesthesia had the

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