Prolonged upper airway obstruction in an eclamptic- challenges of management.
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Date
2009
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College of Health Sciences, University of Ilorin, Ilorin, Nigeria.
Abstract
A 32-year old pregnant woman, Gravida 2, para 1+0 was rushed into the Emergency Ward of our hospital in an unconscious state having complained of severe headache a few hours before admission. She was a known hypertensive being managed on alpha methyldopa and nifedipine.
Physical examination revealed an unconscious woman, with mild pitting pedal oedema. Her respiratory rate was 36 cycles per minute, BP was 150/100 mm Hg. Abdominal examination revealed a term fundal height and foetal heart rate of 160 bpm. Urinalysis showed a proteinuria of 2+ on dipstick. A diagnosis of antepartum eclampsia superimposed on chronic hypertension was made. After initial resuscitation, she had emergency Caesarean section under general anaesthesia, the larynx admitting a small-sized endotracheal tube (6.0mm ID).
Oedema of the larynx was noted at intubation. Post-extubation, she had severe upper airway obstruction necessitating immediate re-intubation and she was admitted into the Intensive Care Unit (ICU).
Gross enlargement of the tongue was noticed on the first postoperative day, which persisted for five weeks, but with gradual reduction in size. Attempts at extubation on the first, fourth and thirteenth postoperative days (P.O.D.) in the ICU resulted in upper airway obstruction and the endotracheal tube was left in-situ till the 20th postoperative day. She was also noticed to have a right-sided hemiplegia and a left facial nerve palsy secondary to a left hemispherical cerebrovascular accident.
This case is presented to highlight the challenges of prolonged upper airway management due to massive tongue enlargement complicating eclampsia.
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Keywords
eclampsia,, upper airway obstruction,, prolonged endotracheal intubation
Citation
2. Bolaji B.O. (2009). Prolonged upper airway obstruction in an eclamptic- challenges of management. The Tropical Journal of Health Sciences Vol 16(2):50-53.