ANESTHETIC CHALLENGE FOR PERIOPERATIVE MANAGEMENT OF ACUTE INTESTINAL OCCLUSION ON A 26-WEEK AMENORRHEA PREGNANCY: ABOUT A RARE CASE IN THE TROPICS

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The risk caused by anesthesia in pregnant women for surgery unrelated to pregnancy is difficult to specify exactly because of the rarity of the indications on the one hand and their very great diversity on the other. We report a clinical case of a 23-year-old pregnant woman Parity 2, Gestity 3, Abortion 0 and Death 0 admitted to the emergency room of the university clinics on 01/30/2022 for excruciating abdominal pain in the form of cramps, abdominal bloating and vomiting for 2 days, in whom the clinical and paraclinical examinations had concluded to an occlusive syndrome probably on flanges seen history of appendectomy. The particulars of the CPA noted moderate dehydration in the context of a full stomach.After a short preparation made of classic conditioning for an acute surgical abdomen (urinary and nasogastric catheter, 2 18-gauge venous lines) with particular preference for a left lateral position before induction, hydro-electrolyte rebalancing, antibiotic prophylaxis, gastric protection. The anesthetic induction was rapid sequence combining propofol (2.5mg/Kg), Suxamethonium, 1mg/Kg Fentanyl 1.5 ɤ/Kg and the Sellick maneuver. Maintenance of anesthesia was done by continuous propofol (3 mg/kg/hour) as well as 2 repeated boluses of titrated fentanyl (0.5 mg/kg). Maternal intraoperative monitoring was standard combined with sequential monitoring of fetal heart sounds using a pinardfetoscope). The intraoperative incident was marked by a fall in blood pressure managed by a small vascular filling with crystalloids associated with a vasoconstrictor (Ephedrine). The intraoperative report noted multiple intestinal adhesions with an area of ​​strangulation leaving the loops viable. Adhesiolysis and loop resuscitation were performed. The duration of the intervention was 3 hours and the pregnant woman was awakened and extubated on the table without incident. The maternal-fetal post-operative follow-up was simple after an observation in the post-operative care room. Anesthesia for bowel obstruction in pregnancy remains a formidable challenge for the anaesthesiologist-resuscitator in our environment with pharmacokinetic imperatives and those related to hemodynamic management. Appropriate equipment as well as continuous staff training would further improve this very specific care in our environment.

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