From the Guidelines
For anesthetic management of a Lower Segment Cesarean Section (LSCS) in a patient with Acute Fatty Liver of Pregnancy (AFLP), general anesthesia with propofol induction is recommended due to its minimal hepatic metabolism and rapid recovery profile, as suggested by 1. When managing AFLP patients for LSCS, it is crucial to consider their coagulopathy, liver dysfunction, and potential for hypoglycemia.
- A thorough pre-operative assessment should focus on liver function tests, coagulation profile, renal function, and glucose levels.
- Administering aspiration prophylaxis with ranitidine and metoclopramide 30 minutes before induction is advisable.
- A rapid sequence induction with propofol 1.5-2mg/kg, if hemodynamically stable, followed by suxamethonium as mentioned in 1, is a suitable approach for ensuring early good intubation.
- Maintenance of anesthesia can be achieved with sevoflurane or desflurane in oxygen, considering the use of remifentanil infusion for additional analgesia.
- Monitoring for hypoglycemia, coagulopathy, and renal dysfunction is essential throughout the procedure.
- Post-operative pain management should involve multimodal analgesia, avoiding medications that could exacerbate liver dysfunction or coagulopathy, as indicated by the need for drugs with minimal hepatic or renal metabolism in 1.
- The use of a urinary catheter for hourly monitoring of urinary output and consideration of a balloon-tipped pulmonary artery catheter or central venous catheter in critically ill patients, as suggested in 1, can help in managing fluid balance and avoiding complications.
- The choice of propofol for induction, as it has no active metabolites, aligns with the principle of selecting drugs with minimal hepatic metabolism, making it a logical choice for AFLP patients undergoing LSCS, as implied by 1.
From the Research
Anesthetic Management for Acute Fatty Liver of Pregnancy (AFLP) during Lower Segment Cesarean Section (LSCS)
- There are no research papers provided that directly address the anesthetic management for AFLP during LSCS.
- However, the provided studies discuss various aspects of anesthetic management, such as:
- The effects of mechanical ventilation and controlled spontaneous respiration on pulmonary function during general anesthesia 2
- Anaesthetic considerations for patients with antiphospholipid syndrome undergoing non-cardiac surgery 3
- Comparative effects of propofol, landiolol, and nicardipine on hemodynamic and bispectral index responses to endotracheal intubation 4
- Comparative aspects of respiratory support via laryngeal air ducts and endotracheal tube for video-assisted oncothoracic operations 5
- Evaluation of intubating conditions in children after sevoflurane induction using propofol or rocuronium bromide 6
- These studies may provide some general insights into anesthetic management, but they do not specifically address the anesthetic management for AFLP during LSCS.