Severe fetal bradycardia in a pregnant surgical patient despite normal oxygenation and blood pressure.
OBJECTIVE
To report and discuss a case of fetal bradycardia in a parturient under anesthesia for cholecystectomy despite normal maternal oxygenation and arterial blood pressure.


METHODS
A 27-yr-old woman (gravida 2 para 1), with a fetus of 34 weeks gestation, received general anesthesia for cholecystectomy. After anesthesia induction and tracheal intubation, anesthesia was maintained with oxygen, sevoflurane and iv remifentanil infusion. While preparing for surgery, the fetal heart rate decreased within about half a minute to 70 beats x min(-1) and remained at that level. The maternal blood pressure, heart rate and oxygen saturation were normal. An emergency Cesarean delivery was performed. The infant had Apgar scores of 1 at one minute, 5 at five minutes, 7 at ten minutes and required resuscitation after birth.


CONCLUSIONS
Ideally, women having non-obstetric surgery during the third trimester of pregnancy will have intraoperative fetal heart rate monitoring.
Ong
Bill Y
BY
Department of Anesthesia, University of Manitoba, Winnipeg, Manitoba, Canada. ong@cc.umanitoba.ca
Baron
Ken
K
Stearns
Eric L
EL
Baron
Cynthia
C
Paetkau
Don
D
Segstro
Ron
R
D000328:Adult; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001034:Apgar Score; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D001919:Bradycardia / Q000209:etiology*; D002585:Cesarean Section; D002763:Cholecystectomy / Q000009:adverse effects*; D005260:Female; D005316:Fetal Distress / Q000209:etiology*; D005323:Fetal Monitoring; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D008738:Methyl Ethers / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage / Q000097:blood*; D010880:Piperidines / Q000008:administration & dosage; D011247:Pregnancy; D000077208:Remifentanil; D012720:Severity of Illness Index; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D010100:Oxygen