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

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 p...

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Autores principales: Takahashi, Miyuki, Hotta, Kunihisa, Inoue, Soichiro, Takazawa, Tomonori, Horiuchi, Tatsuo, Igarashi, Takashi, Takeuchi, Mamoru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6967107/
https://www.ncbi.nlm.nih.gov/pubmed/32026066
http://dx.doi.org/10.1186/s40981-019-0302-6
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author Takahashi, Miyuki
Hotta, Kunihisa
Inoue, Soichiro
Takazawa, Tomonori
Horiuchi, Tatsuo
Igarashi, Takashi
Takeuchi, Mamoru
author_facet Takahashi, Miyuki
Hotta, Kunihisa
Inoue, Soichiro
Takazawa, Tomonori
Horiuchi, Tatsuo
Igarashi, Takashi
Takeuchi, Mamoru
author_sort Takahashi, Miyuki
collection PubMed
description 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.
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spelling pubmed-69671072020-02-04 Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report Takahashi, Miyuki Hotta, Kunihisa Inoue, Soichiro Takazawa, Tomonori Horiuchi, Tatsuo Igarashi, Takashi Takeuchi, Mamoru JA Clin Rep Case Report 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. Springer Berlin Heidelberg 2019-12-19 /pmc/articles/PMC6967107/ /pubmed/32026066 http://dx.doi.org/10.1186/s40981-019-0302-6 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Case Report
Takahashi, Miyuki
Hotta, Kunihisa
Inoue, Soichiro
Takazawa, Tomonori
Horiuchi, Tatsuo
Igarashi, Takashi
Takeuchi, Mamoru
Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
title Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
title_full Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
title_fullStr Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
title_full_unstemmed Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
title_short Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
title_sort mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6967107/
https://www.ncbi.nlm.nih.gov/pubmed/32026066
http://dx.doi.org/10.1186/s40981-019-0302-6
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