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In pregnancy non-obstetric surgery involves many significant difficulties for the anesthetist. The majority of these procedures are non-elective and some are life-threatening. This report explains the preoperative preparation and general anesthetic method for a 27week pregnant woman with osteofibrotic mass narrowing the left optic canal causing rapidly advancing loss of vision. respiratory system examination. Airway evaluation determined mallampati score of 1. Preoperative tests: Hb 11.1, Htc 33.6, WBC 12,200, Na+ 139, K+ 4.1, glucose 80, Cr 0.5, sedimentation 52, ECG and coagulation test normal. Due to the possibility of premature birth, before surgery 2 doses of Betamethasone intravenous (iv) were administered at 12 hour intervals to ensure maturation of the baby’s lungs and then 48 hours waiting was allowed. For thromboembolism prophylaxis, a single dose of 0.4 mL subcutan (sc) enoxaparin was administered the night before surgery. One hour before surgery, iv ranitidine was administered. The patient was monitored with ECG DII lead and pulse oxymetry, noninvasive and invasive blood pressure, capnography, urine and axillary temperature with two venal (18 Gauge, 20 Gauge) and left radial artery cannula (20 Gauge) inserted. To reduce aorto-caval pressure, and to shift the uterus to the left, a pillow was placed under the right hip. With a mask, 100% oxygen (O2) was administered for 3 min for preoxygenation, 6 mg/kg iv thiopental was titrated and after loss of consciousness the Sellick Maneuver was applied. After intravenous 1 mg/kg rocuronium, 60 s waiting ensued and then the patient was intubated with number 7 cuff endotracheal tube. For prophylaxis 1 g iv cefazolin was administered. Anesthesia maintenance was ensured with 50% O2/air, 1.5% sevoflurane and 1 μg/kg/hr fentanyl infusion. Mechanical ventilation was applied in volume control mode with 30-35 mmHg ETCO2. During the operation no additional neuromuscular blocker was administered. In the operating room, an obstetrician monitored cardiotocography and continuous fetal heart rate (FHR). In the preoperative period FHR was 150/min, while during surgery FHR was 135/min. Arterial blood gas analysis was within normal physiological limits. The surgery lasted two hours, during the operation the patient’s hemodynamics were stable and 1000 mL isotonic and 500 mL isolate-S was administered. Total urine output was above 2 ml/kg. Intraoperative blood sugar was 94 mg/dL. At the end of surgery the patient was fully conscious, placed in lateral position and moved to the recovery unit. With stable hemodynamics the patient was monitored for two hours and then sent to the ward. On the postoperative first day, the patient was observed to be stable in the ward. Preoperative vision degree was 2/10 which improved to 7/10 on the postoperative second day. With all complaints resolving, the patient was discharged on the 3rd day postoperative. Introduction In developed countries, the incidence of non-obstetric surgery during pregnancy is about 1-2% [1]. The most common reasons for surgery in pregnancy are appendicitis, cholecystitis, ovarian torsion, trauma and maternal malignant pathologies. Studies have reported that of non-obstetric surgeries during pregnancy, 42% are in the first trimester, 35% are in the second trimester and 23% are in the third trimester [2]. This case report presents the anesthetic approach for a 27-week pregnant woman undergoing endoscopic sinus surgery for complaint of rapidly advancing loss of vision due to left optic mass. We aimed to recall the anesthetic methods for non-obstetric surgery on the basis of this case.

The Anesthetic Approach for a 27-Week Pregnant Woman Undergoing Endoscopic Sinus Surgery