Repeated episodes of respiratory distress in an obese parturient after cesarean delivery.
A 25-yr-old obese parturient with mild asthma underwent an uneventful spinal anesthetic for primary cesarean delivery. Within 4 h after delivery, the patient twice developed acute shortness of breath, inspiratory stridor, and hypoxemia that required intubation. A battery of blood tests revealed no evidence of an allergic reaction. She had a normal echocardiogram and chest computed tomography, but her neck computed tomography showed an enlarged left thyroid lobe asymmetrically compressing the endotracheal tube cuff. We hypothesized that, after delivery, decreased maternal vascular capacitance increased central venous pressure such that venous engorgement of an undiagnosed goiter may have caused symptomatic tracheal compression.
Wittels
Bernard
B
Department of Anesthesiology, Rush Medical College, Rush University Medical Center, 1653 West Congress Parkway, Suite 739 Jelke, Chicago, IL 60612-3833, USA. bernard_wittels@rush.edu
Attia
Tamer A
TA
Al-Qamari
Abbas
A
Jaycox
Matthew P
MP
D000328:Adult; D000402:Airway Obstruction / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D000775:Anesthesia, Spinal; D001249:Asthma / Q000150:complications; D002496:Central Venous Pressure; D002585:Cesarean Section / Q000009:adverse effects*; D015505:Chest Tubes; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006042:Goiter / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007442:Intubation, Intratracheal / Q000295:instrumentation; D050498:Live Birth; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D012008:Recurrence; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013965:Thyroidectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018924:Vascular Capacitance