Successful delivery in a morbidly obese patient after failed intubation and regional technique

Abstract

Editor-We would like to highlight an infrequent but serious adverse effect of tramadol. We report a case of generalized tonic-clonic seizure associated with sympathetic nervous system hyperactivity, which included profuse diaphoresis, tachycardia (HR: 136 beats min 21), hypertension (BP: 160/110 mm Hg), and widespread erythema after the administration of tramadol. A healthy 49-yr-old male was admitted to hospital for management of a fractured humerus. The only medication the patient received was morphine 30 mg followed by oral tramadol 100 mg approximately 40 min before the grand mal seizure. Tramadol can precipitate seizures in epileptic patients 1-3 by lowering the seizure threshold. There have been several case reports of tramadol precipitating a seizure in non-epileptic patients. However, our patient had a more complicated seizure presentation, which included generalized erythema, and profuse sustained diaphoresis. Tramadol increases cerebral serotonin activity by partial inhibition of its uptake, particularly when it is given in combination with other drugs including morphine. This increased serotonin activity can produce serotonin syndrome which is characterized by disorders in cognitive-behavioural, neuromuscular, and autonomic function. 4 5 To qualify for the diagnosis, it has been suggested that a patient should have at least one or two manifestations from each of these functional categories. There is no formal test for the diagnosis of serotonin syndrome. The onset of clinical effects is relatively rapid (minutes to a few hours). Management is discontinuation of the causative agents with supportive treatment and the clinical symptoms and signs usually resolve within 24 h. Hyperthermia should be treated with active cooling. Rigidity, seizures, and agitation should be treated with benzodiazepines. Severe symptoms have been treated successfully with cyproheptadine-a 5-HT2 antagonist.

Untitled

“…So choice of local infiltration anesthesia was done and effectively managed with excellent outcome of mother but fetal outcome was grave. There are some indication and case report that LSCS is done under local infiltration anesthesia [26][27][28][29]. But most of cases are used local anesthetic infiltration, entonox inhalation and letter on fentanyle with spontaneous ventilation.…”

Cesarean section under local anesthesia: A step forward or backward?

“…However, there are many cases where local anesthesia has been highly useful and even life saving such as patients who are morbidly obese, have difficult airway or severe coagulopathy. [1] We are highlighting the successful conduct of Cesarean section under local anesthesia in a 26-year old, ASA III woman, with previous one lower segment Cesarean section (LSCS). She presented to casualty with scar tenderness and fetal distress (fetal heart rate between 90 and 100 per minute), hence was scheduled fo an emergency LSCS.…”