hello, i met a young eclamptic patient a few days ago and she had very often seizure attack despite given MgSO4 preoperatively...so, the decision to terminate the pregnancy was made as soon as possible, ...my teacher decided to manage this patient with General anesthesia with RSI (with muscle relaxant)... During the operation, the patient given maintenance dose muscle relaxant and show no sign of seizure ( but no EEG was available), the MgSO4 stopped during the operation and the baby delivered well (though the neonate wasn't well), and after the operation, the patient transferred immediately to the ICU...
now, my questions are :
1. is that already a right way to manage this patient? i mean, so the patient is having a frequent active seizure...and we know that giving a muscle relaxant (especially the maintenance muscle relaxant) will damp the signs of the seizure...without EEG, how can we know that this patient is having a seizure?
because as i know that the seizure would increase the CMRO2 and it means need more delivery of O2 and it is quiet labile to have if we need the anesthetics still going on (MAP usually quiet low) ..am i right?
2. if i can't use the muscle relaxant in this patient, should i use the awake intubation or fiberoptic intubation instead (considering that a pregnant woman also have some difficult airway)?
3. Can i still use the MgSO4 intraoperatively to prevent the seizure? how can i combine it with the intraoperative fluid since the MgSO4 would increase the risk of water intoxication (as well as the oxytocin) too?
4. Considering that the eclamptic patient still had a quiet risk of having another seizures in variable few days (or weeks) after the operation....when is the right time to extubate the patient?
sorry if all those questions are very simple and even might be a silly questions ..i am new to anesthesia and really want to learned anesthesia
...please help..thx u