Abstract
Purpose
This case report describes the use of a Laryngeal Mask Airway in a morbidly obese parturient with the H.E.L.L.P. syndrome. An urgent Caesarean section was required because of vaginal bleeding and fetal distress.
Clinical features
The patient was a 32 year old G3, T1, P1, L1 who presented with epigastric pain, headache, vomiting, and diarrhoea. She was hypertensive (180/110 mmHg) and thrombocytopaenic (18 × 10−9 · L−1). Examination of the airway revealed a short neck, receded jaw, full dentition, large breasts and she was considered to be a potential intubation problem. The patient required an awake intubation using a technique that minimized hypertension, aspiration risk, airway trauma, and hypoxia. A laryngeal mask was used to facilitate tracheal intubation, and the patient tolerated the procedure with no adverse outcome.
Conclusion
The LMA has a place to facilitate potentially difficult awake tracheal intubation with the pregnant patient.
Résumé
Objectif
Cette observation décrit l’usage du masque laryngé (ML) chez une patiente obèse souffrant du syndrome HELLP. Une césarienne était devenue urgente à cause d’un saignement vaginal et d’une détresse foetale.
Caractéristiques cliniques
La patiente était âgée de 32 ans et présentait une douleur épigastrique, de la céphalée, des vomissements et de la diarrhée. Elle était de plus hypertendue (180/110) et thrombocytopénique (18 × 10−9 · L−1). L’examen des voies aériennes a révélé un cou court, une mâchoire fuyante, une denture complète et des seins volumineux, ce qui permettait d’anticiper une intubation difficile. A cause de ces éléments, une intubation vigile était indiquée avec une technique capable de minimiser l’hypertension, le risque d’aspiration, les traumatismes des voies respiratoires et l’hypoxie. Un masque laryngé a servi à faciliter l’intubation de la trachée et la patiente a toléré la manoeuvre sans complications.
Conclusion
Le ML a sa place comme aide à l’intubation vigile des voies aériennes difficiles chez la femme enceinte.
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Godley, M., Reddy, A.R.R. Use of LMA for awake intubation for Caesarean section. Can J Anaesth 43, 299–302 (1996). https://doi.org/10.1007/BF03011747
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DOI: https://doi.org/10.1007/BF03011747