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THE FEBRILE PARTURIENT WITH MEASLES AND PNEUMONIA: REGIONAL OR GENERAL ANAESTHESIA?
Author(s):
Yahaya, Z.*
Affiliations:
KK Women and Children's Hospital, Women Anaesthesia, singapore, Singapore
ESRA Academy. Yahaya Z. Sep 13, 2017; 190803; 107 Topic: REGIONAL ANAESTHESIA (RA) IN SPECIFIC SUBPOPULATIONS
Dr. Zanariah Yahaya
Dr. Zanariah Yahaya

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Abstract
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Background and Aims:

Measles is a highly-contagious respiratory disease, characterized by rash with potential complications such as pneumonia or encephalitis. Pregnant women are at increased risk for complications, including adverse perinatal outcomes, with up to 10% maternal mortality rate. Treatment is largely supportive with no specific antiviral therapy available.

Methods:

A 31 year-old female at 27 weeks gestation was initially admitted for pneumonia, with bilateral consolidation evident on CXR. She remained febrile and developed a generalised maculo-papular rash. Throat swab was positive for measles RNA. She subsequently went into premature labour with abnormal fetal presentation.  An emergency caesarean delivery was planned. Single-shot spinal technique (13 mg 0.5% heavy bupivacaine, fentanyl 15mcg and morphine 100mcg) using a 27G pencil-point needle was performed in the sitting position. Surgery proceeded uneventfully and a  baby girl was delivered. 

Results:

The safety of neuraxial anaesthesia in septic parturients remains a controversy. The theoretical risk of introducing infective viral material into the CNS during a neuraxial block, resulting in meningitis or encephalitis has been discussed. Moreover, if post-operative headache occurs, distinguishing neurological complications secondary to neuraxial blockade from those arising from the disease may be a challenge. Our choice of spinal anaesthesia minimizes the risk of pneumonia exacerbation and potential ARDS. Due to the extensive rash, precautions were taken to avoid the skin lesions during spinal needle placement. The use of pencil point needle has also been advocated as tissue coring is prevented.

Conclusions:

 Multidisciplinary approach with tailored anaesthetic technique is necessary for favourable maternal and foetal outcomes.

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