Brazilian Journal of Anesthesiology
http://www.rba.periodikos.com.br/article/doi/10.1016/j.bjane.2020.10.011
Brazilian Journal of Anesthesiology
Case Report

Thromboelastography as a point-of-care guide for spinal anesthesia in an eclamptic patient: a case report

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Neuraxial anesthesia is a standard of care during parturition. Since bleeding diathesis is a contraindication to neuraxial techniques, data about its safe administration in a thrombocytopenic milieu is limited and evolving. Thrombocytopenia associated with preeclampsia or eclampsia and hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome leads to significant maternal and neonatal morbidity. We present a case of uneventful spinal anesthesia for urgent cesarean section in an eclamptic patient with a precipitous drop in platelet count from 124,000 to 97,000 per cubic millimeter under thromboelastography (TEG) guidance.

Thrombocytopenia Cesarean section Thromboelastography Neuraxial anesthesia Preeclampsia Eclampsia

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2 American College of Obstetricians and Gynecologists Thrombocytopenia in pregnancy: practice bulletin nº 166 Obstet Gynecol, 128 (2016), pp. e43-53

3 L.O. Lee, B.T. Bateman, S. Kheterpal, et al. Multicenter perioperative outcomes group investigators. Risk of epidural hematoma after neuraxial techniques in thrombocytopenic parturients: a report from the multicenter perioperative outcomes group Anesthesiology, 126 (2017), pp. 1053-1063

4 American Society of Anesthesiologists task force on obstetric anesthesia Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists task force on obstetric anesthesia Anesthesiology, 106 (2007), pp. 843-863

5 L.M. Goetzl, ACOG committee on practice bulletins-obstetrics ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists Number 36, July 2002. Obstetric analgesia and anesthesia Obstet Gynecol, 100 (2002), pp. 177-191
 

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