Question

A 20-year-old G1P0 parturient at 32 weeks gestation with no medical problems was in a high-speed motor vehicle accident. She was wearing a seatbelt and has only abrasions on her face and chest. On arrival to the department she is awake and alert. Maternal vital signs are BP 100/60, HR 120, RR 20. Fetal heart rate evaluation shows a persistent fetal bradycardia in the 70-bpm range. A large-bore IV is placed and the patient is taken to the operating room. The most appropriate anesthetic choice would be

A. Etomidate 0.2 mg/kg, succinylcholine 1.5 mg/kg, both IV
B. Propofol 2 to 3 mg/kg, succinylcholine 1.5 mg/kg, both IV
C. Spinal injection of bupivacaine, 12 mg, and fentanyl, 25 mcg
D. Spinal injection of bupivacaine, 12 mg, without fentanyl
E. Inhalational mask induction with preserved spontaneous ventilation until anesthetized to avoid emergent tracheal intubation in a trauma patient 156

Answer 1

The most appropriate anesthetic choice for the G1P0 parturient at 32 weeks gestation experiencing fetal bradycardia post-accident is Propofol 2 to 3 mg/kg and succinylcholine 1.5 mg/kg, both IV, due to the need for rapid induction and the emergency nature of the situation.

Step-by-step explanation:

The patient presented is a 20-year-old G1P0 at 32 weeks' gestation involved in a high-speed motor vehicle accident. She is experiencing a persistent fetal bradycardia with a heart rate in the 70-bpm range. Given the urgency of the situation and the stable condition of the mother apart from the evidence of fetal distress, the best anesthetic choice to facilitate an expedient caesarean delivery would likely be choice B, which is Propofol 2 to 3 mg/kg, succinylcholine 1.5 mg/kg, both IV. This combination provides rapid induction suitable for emergency caesarean delivery, and it is preferable over etomidate in this scenario because etomidate could potentially worsen fetal bradycardia. While spinal anesthesia with bupivacaine could be considered, the urgency here prioritizes immediate surgery, which might not be afforded by the set-up time for a spinal block. Inhalational mask induction is generally less favored in an emergency setting due to the risk of aspiration and slower induction times. Moreover, maintaining spontaneous ventilation might not be safe given the potential for rapid deterioration of the mother's condition during induction and surgery.