Anesthetic Management for a Congenital Methemoglobinemia Parturient Undergoing Cesarean Section : Case Report

Abstract

Background and Objective   : Methemoglobinemia (MetHba),  is the oxidized form of hemoglobin in the blood stream.  The MetHba could not bind with oxygen in the lung alveoli and could not release oxygen to the tissues and organs.  There are  two types of this condition, congenital and acquired MetHba.  If it exceeds 70% the patient could not survive. We reported the administration of general anesthesia to a parturient with congenital methomoglobinemia who need an emergency cesarean section to save the mother and a fetus.

Case : A 37-year-old pregnant woman who carried twin pregnancy for 38 weeks was anesthetized.  One fetus was dead and the other survived but facing the fetal distress syndrome.  There was no alternative but Cesarean section in  Kalasin Provincial Hospital. The 100% oxygen was given before the general anesthetic and continued during operation.

Results : We gave 100% oxygen to this patient prior to general anesthesia and during operation.  The procedure produced the satisfactory result.  The dead fetus was removed and the one with fetal distressed condition was delivered safely while the mother survived the anesthesia astonishingly well even though she was detected low blood oxygen concentration (SpO2) throughout the Cesarean Section.  The parturient condition was clinically confirmed as the congenital methemoglobinemia because she lacked the enzyme called NAD-methemoglobin reductase I (cytochrome  b  reductase).

Conclusions : The result of administering 100% oxygen prior to general anesthesia and maintaining such oxygen during the operation was highly satisfied, the dead fetus was successfully removed while the living one was safely delivered and the mother came out normally.

Keywords   : Anesthesia,  fetal distress condition, congenital methemoglobinemia, twin pregnancy,