Cervical Encirclage in 14 weeks pregnant with MS

Started by jafo1964, September 03, 2009, 12:51:42 PM

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a 22 year old woman is posted for encirclage for cervial incompetence. Procedure is likely to last 10 to 15 minutes only

She is a known case of Mitral stenosis of Rheumatic etiology
Her effort tolerance is 4 METS
she has a history of Dyspnoea on Exertion NYHA class 2
Her last Echo shows a MVO size of 1 cm2. She has mild PHT and her LV function is good
She is in sinus rhythm and on regular anti- CCF therapy

our plan
Debated about short duration day care procedure and role of Spinal anesthesia
Also debated about potential for full stomach scenario and aspiration risk
Wondered about the utility of blocks like pudendal and paracervical and dropped them due to lack of experience and confidence
IV ranitidine and IV MEtoclopramide 10 mg given 30 min before surgery
Routine monitors including ETCO2 and IV line started. Fetal heart rate monitoring started
Patient received Glycopyrrolate 0.2 mg + Fentanyl 2 mcg /kg
SC Terbutaline was used as tocolytic as only that was available
Induced with Propofol 2.5 mg / kg mixed with Lignocaine 1 mg /kg
Once under, size 3 PLMA inserted Positioning confirmed
N2o + O2 + Isoflurane intial IPPV followed by Spontaneous assisted ventilation
Ryle's tube inserted
Procedure in lithotomy lasted 17 minutes
Recovered in supine and extubated fully awake

Is this technique good enough or are there any holes to punch into it
Was it OK to overcome our intial urge to be safe and just go with a spinal since we hoped to return patient home as early as possible

Thanks for your inputs


Well, by putting in an LMA you have played a safer mode than me. I might not have put in an LMA. I would have done it under TIVA only. but you were better.
Wait for a few more months and she will be back for a section, and that will be the real test.
Take care.

kalpesh shah

hi, well managed with the propofol, but is the use of propofol in pregnant lady is FDA approved? please guide us.

in other scenario is the use of propofol safe in new borns?



Why did u not try paracervical block? its easy to perform, patient is haemodynamically stable and pt can walk home