Management of a parturient with an acute exacerbation of idiopathic pulmonary haemosiderosis and posterior spinal instrumentation
Division of Women’s Anaesthesia, Department of Anaesthesiology, Duke University Medical Centre, Box 3094, Durham, NC 27710, USA
* Corresponding author. E-mail: ticka98{at}btinternet.com
Idiopathic pulmonary haemosiderosis (IPH) is a rare condition associated with diffuse alveolar haemorrhage and pulmonary fibrosis. We describe the anaesthetic management of a parturient with a history of posterior spinal fusion presenting with an acute exacerbation of IPH necessitating vaginal delivery at 34 weeks gestation. We used a spinal catheter for labour analgesia and bilevel positive airway pressure (BIPAP) ventilation to improve oxygenation during labour. An arterial line sited to allow frequent arterial blood gas sampling also facilitated continuous cardiac output monitoring. The use of a carefully titrated neuraxial block for analgesia, in conjunction with BIPAP, was associated with minimal haemodynamic and respiratory compromise during labour in this patient.
Keywords: anaesthesia, obstetric; analgesic techniques, subarachnoid; equipment, catheters subarachnoid; idiopathic pulmonary haemosiderosis; ventilation, bilevel positive airway pressure
This case report was presented in part at the 39th annual meeting of the Society of Obstetric Anesthesia and Perinatology in Banff, Alberta, May 16–19, 2007.