Anesthetic implications of emergent Cesarean section in a parturient with Noonan syndrome and bacterial endocarditis

Chase, Charles J.; Holak, Elena J.; Pagel, Paul S.

doi:10.1016/j.jclinane.2012.11.016

Cited by 10 publications

(6 citation statements)

References 20 publications

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“…In the 36 instances where we needed to clarify details of trial methodology or request missing data, nine authors responded with the required information. 24,38,[40][41][42]51,55 Characteristics of the case reports and series are detailed in Table 1. The case reports/series, describing the use of videolaryngoscopes in 100 patients, provided an indication of the potential value of videolaryngoscopy as a first choice and rescue modality in patients with and without predictors of difficult intubation.…”

Section: Resultsmentioning

confidence: 99%

Comparison of videolaryngoscopy and direct laryngoscopy for tracheal intubation in obstetrics: a mixed-methods systematic review and meta-analysis

Howle

Onwochei

Harrison

et al. 2021

Can J Anesth/J Can Anesth

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The incidence of difficult and failed intubation is higher in obstetrical patients than in the general population because of anatomic and physiologic changes in pregnancy. Videolaryngoscopy improves the success rate of intubation and reduces complications when compared with direct laryngoscopy in adults; however, it is not known whether this extends to obstetrical surgery. The aim of this study was to examine the efficacy, efficiency, and safety of videolaryngoscopy compared with direct laryngoscopy in obstetrics. Source Central, CINAHL, Embase, MEDLINE and Web of Science databases were searched from inception to 27 May 2020 with no restrictions. Inclusion criteria included randomized-controlled trials (RCTs), observational studies, case series, and case reports that reported the application of videolaryngoscopy to intubate the trachea in pregnant patients having general anesthesia. Principal findings Overall, four RCTs with 428 participants, nine observational studies, and 35 case reports/series with 100 participants were included. On meta-analysis of three trials, the co-primary outcomes of first-attempt success rate (risk ratio, 1.02; 95% confidence intervals [CI], 0.98 to 1.06; P = 0.29; I 2 = 0%) and time to tracheal intubation (mean difference, 1.20 sec; 95% CI,-6.63 to 9.04; P = 0.76; I 2 = 95%) demonstrated no difference between videolaryngoscopy and direct laryngoscopy in parturients without difficult airways. Observational studies and case reports underline the role of videolaryngoscopy as a primary choice when difficulty with tracheal intubation is expected or as a rescue modality in difficult or failed intubations. Conclusions Evidence for the utility of videolaryngoscopy continues to evolve but supports its increased adoption in obstetrics where videolaryngoscopes should be immediately available for use as a first-line device. Trial registration PROSPERO (CRD42020189521); registered

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Section: Resultsmentioning

confidence: 99%

Comparison of videolaryngoscopy and direct laryngoscopy for tracheal intubation in obstetrics: a mixed-methods systematic review and meta-analysis

Howle

Onwochei

Harrison

et al. 2021

Can J Anesth/J Can Anesth

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“…However, only a few case reports currently exist on management of a parturient with Noonan syndrome. [9][10][11][13][14][15] In addition to the baseline cardiopulmonary complexities presented, maternal physiologic changes add in additional challenges for the anesthesiologist. During pregnancy, both cardiac output (CO) and HR increase to meet the physiologic demands of the growing fetus.…”

Section: Discussionmentioning

confidence: 99%

Severe Cardiopulmonary Disease in a Parturient With Noonan Syndrome

Siegrist

Deegan

Dumas

et al. 2020

Semin Cardiothorac Vasc Anesth

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Noonan syndrome is a relatively common genetic disorder and the second most common cause of congenital heart disease after trisomy 21. The spectrum of cardiac anomalies in Noonan syndrome typically involves pulmonary valve stenosis occasionally in conjunction with hypertrophic cardiomyopathy. Mitral valve involvement is a rare finding in Noonan syndrome and is most commonly associated with either mitral valve prolapse or abnormal valvular insertion causing left ventricular outflow tract obstruction. Patients with Noonan syndrome typically have preserved fertility and, given the success of cardiac surgery and medical management of heart failure in this population, are beginning to present more commonly as parturients in adulthood. Maternal physiologic changes during pregnancy introduce an added complexity to hemodynamic management and anesthetic considerations during labor and delivery. In this article, we present a case of a patient with Noonan syndrome with severe mitral stenosis, pulmonary valve insufficiency, and severe restrictive and obstructive pulmonary disease who presented preterm for delivery due to increased dyspnea at rest. Here we review the pathophysiology behind Noonan syndrome and peripartum management strategies in a patient with severe combined cardiac and pulmonary disease.

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“…While using a higher dose of bupivacaine could guarantee an adequate effect in standard 'single shot' techniques it would be difficult to avoid adverse effects such as hypotention and patient discomfort [11]. Although no data regarding the appropriate dose of local anesthetic for spinal or epidural anesthesia in patients with spinal deformities is available our conventional dose of hyperbaric bupivacaine with morphine appears to be adequate [9].…”

Section: Discussionmentioning

confidence: 99%

“…There are two options in cases of failed block after skin incision, i.e., conversion to general anesthesia with tracheal intubation and continuation of spinal anesthesia using systemic supplementation we were able to complete the surgery using additional analgesics and sedatives [11]. If we had Chase et al reported successful rapid-sequence induction and endotracheal intubation using videolaryngoscopy for a Mallampati class 2 parturient with Noonan syndrome at 23 weeks' gestation [9]. However if physical examination shows higher Mallampati score, rapid-sequence intubation will be more difficult, and awake intubation using direct laryngoscopy or video laryngoscopy with topical anesthesia would become alternative methods [5].…”

Section: Discussionmentioning

confidence: 99%

“…Regional anesthesia may be technically difficult with the kyphoscoliosis and lumbar lodosis [4].The epidural and subarachnoid spaces are difficult to detect because of the abnormal curvature of the spine. Six cases of anesthetic management in a parturient with Noonan syndrome under both general and regional anesthesia have been reported [4][5][6][7][8][9]. Although previous reports have suggested that anesthesiologists should evaluate a patient early during the prenatal period we had no opportunity to assess the patient until emergency Cesarean section was selected, and we had to deal with issues associated with anesthesia as they arose [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Anesthesia for Emergency Cesarean Section in a Parturient with Noonan Syndrome

Hamada¹

2013

J Anesth Clin Res

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Patients with Noonan syndrome are characterized by many anesthetic problems, primarily related to potential difficult airway and technical issues with regional anesthesia. We describe the anesthetic management of a difficult case of a parturient with Noonan syndrome requiring emergency Cesarean section under spinal anesthesia. We had to evaluate the patient within a limited amount of time because of fetal distress. Although spinal injection was easily accomplished, it resulted in inadequate sensory block requiring supplemental analgesics and sedatives. B AFigure 1: Standing lumbar spine anteroposterior (A) and lateral (B) X-ray images in the nonpregnant state showing kyphoscoliosis.

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Anesthetic implications of emergent Cesarean section in a parturient with Noonan syndrome and bacterial endocarditis

Cited by 10 publications

References 20 publications

Comparison of videolaryngoscopy and direct laryngoscopy for tracheal intubation in obstetrics: a mixed-methods systematic review and meta-analysis

Comparison of videolaryngoscopy and direct laryngoscopy for tracheal intubation in obstetrics: a mixed-methods systematic review and meta-analysis

Severe Cardiopulmonary Disease in a Parturient With Noonan Syndrome

Anesthesia for Emergency Cesarean Section in a Parturient with Noonan Syndrome

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