Anesthesia Epidural anesthesia Complications
December 25, 2014 | 45,00 EUR | answered by Dr. med. Ralf Berg
Dear Dr.,
I have a question:
What conclusions can be drawn from the 2 protocols?
What can be read from the two protocols?
http://www.directupload.net/file/d/3847/zxssohqy_jpg.htm
http://www.directupload.net/file/d/3847/mhajmuzu_jpg.htm
"Tapnea: 30 s ."
Some additional data: (measurement protocol)
22:03
pH: 7.305
BE: -1.7
PCO2: 52.3
PO2: 17.8
SO2: Interference (5)
22:24
pH: 7.269
PCO2: 66.7
BE: 1.0
PO2: 10.7
PCO2: 66.7
O2 sat: 16.7
1:15
ph: 7.45
PO2: 81.4
PCO2: 36.6
SO2: 96.1
A cesarean section (C-section) was performed under epidural anesthesia (PDA).
Dear inquirer,
I can interpret the following:
At 22:49, a 57 kg 21-year-old pregnant woman was admitted to the delivery room. There is no mention of epidural anesthesia in the protocol, possibly it was already in place in the delivery room and had been filled there. From your information, I can conclude that a C-section started in epidural anesthesia at 21:49, which was carried out very quickly, so I assume that after the medication (2x 5 ib Syntocinon and 1x Augmentin antibiotics given at 10 pm), the baby was delivered by C-section after about 10 minutes. The initial blood pressure of 90/60 stabilized at 120/80, oxygenation was good the whole time (saturation above 90%), and the patient was apparently transferred from the operating room to the recovery room at 22:15. So far, I do not see anything unusual.
The epidural anesthesia seemed to have worked very well and may have spread well beyond the navel. From the second protocol, it is evident that the circulation was stabilized with Voluven infusions. This is also fine and necessary.
While the first blood gas analysis protocol showed a slightly elevated CO2 level (55), there is no information on oxygenation (except that the patient was breathing room air at that time), the second blood gas analysis at 22:14 showed a PCO2 value of 66 and reduced oxygen saturation, indicating a possible CO2 narcosis, where the patient may not have breathed deeply or frequently enough. This can be a complication of epidural anesthesia if the effects rise above the navel, causing respiratory depression due to paralysis of the thoracic respiratory muscles, and in extreme cases, even the diaphragm. This leads to inadequate CO2 elimination, resulting in CO2 build-up in the blood, reducing the drive to breathe, causing the patient to "forget" to breathe. If I interpret your additional note of apnea for 30 seconds correctly, it seems that the monitoring detected this and triggered an alarm.
There is no information on what was done in response, but the last blood gas analysis at 1:15 appears to be normal again.
Respiratory depression with a lying epidural is a typical complication possibility, as indicated in the informed consent form for epidural anesthesia. It cannot be entirely prevented. What is essential is continued monitoring post-operation, as the epidural anesthesia lasts much longer (up to 2 hours) and can spread further upwards.
Monitoring and timely responses seem to have taken place, and the issue appears to have been resolved by the last blood gas analysis.
It cannot be determined from these records whether there was prolonged hypoxia, as there are no protocols between the blood gas analysis at 22:24 and any alarms triggered until the check at 1:15.
Best regards,
R. C. Berg
