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一名难治性癫痫持续状态患者的急诊剖宫产术:麻醉期间挑战的病例报告

Emergency cesarean section of a patient with refractory status epilepticus: A case report of challenges during anesthesia.

作者信息

Park Jin Soo, Chung Jin Hun, Kim Nan Seol, Jung Ho Soon, Seo Yong Han, Gong Hyung Youn, Ji Jae Yong, Park Yu Jun, Jung Jun Yong, Chun Hea Rim

机构信息

Department of Anesthesiology and Pain Medicine, Affiliated Soonchunhyang University Hospital Cheonan, Cheonan-si, Chungcheongnam-do, Republic of Korea.

出版信息

Medicine (Baltimore). 2024 May 3;103(18):e37988. doi: 10.1097/MD.0000000000037988.

Abstract

INTRODUCTION

Maternal epilepsy is a critical condition that can significantly affect mothers and fetuses. Notably, the admission of a laboring mother with uncontrolled refractory status epilepticus (RSE) to the operating room presents a challenging scenario for anesthesiologists.

THE MAIN SYMPTOMS OF THE PATIENT AND THE IMPORTANT CLINICAL FINDINGS

A 30-year-old primigravida was transferred to the operating room for an emergency cesarean section. Cesarean section was performed after a provisional diagnosis of preeclampsia was made.

THE MAIN DIAGNOSES, THERAPEUTIC INTERVENTIONS, AND OUTCOMES: Cesarean section was performed under general anesthesia. During the postoperative period, the patient exhibited no seizure activity in the brain; however, she experienced mild cognitive dysfunction for up to 6 months postdelivery. The neonate were discharged without any complications.

CONCLUSION

Inducing anesthesia in pregnant women with ongoing seizure activity are challenging; however, anesthesiologists provide judgment based on the balance between the safety of the mother and fetus and the balance between patient monitoring and the progression of anesthesia. This challenge can be addressed through multidisciplinary collaboration.

摘要

引言

孕产妇癫痫是一种严重疾病,会对母亲和胎儿产生重大影响。值得注意的是,对于正在分娩且难治性癫痫持续状态(RSE)未得到控制的母亲,将其送入手术室对麻醉医生来说是一个具有挑战性的情况。

患者的主要症状及重要临床发现

一名30岁初产妇被转入手术室进行紧急剖宫产。在初步诊断为子痫前期后进行了剖宫产。

主要诊断、治疗干预及结果:剖宫产在全身麻醉下进行。术后期间,患者脑部未出现癫痫发作活动;然而,她在产后长达6个月的时间里出现了轻度认知功能障碍。新生儿无任何并发症出院。

结论

对正在发作癫痫的孕妇实施麻醉具有挑战性;然而,麻醉医生会基于母亲和胎儿的安全平衡以及患者监测与麻醉进展之间的平衡做出判断。这种挑战可通过多学科协作来应对。

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