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Anaesthetic management of a pregnant women taking sildenafil for intra uterine growth retardation undergoing caesarean section: a case report

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Kumar S., Nayak S. S., Yadav U., Yadav R.

The role of Sildenafil was found in the potential weight gain of the foetus in pregnant women with intrauterine growth retardation (IUGR). Sildenafil acted by inhibiting phosphodiesterase type 5 (PDE5), which was an important enzyme responsible for the degradation of Cyclic guanosine monophosphate (cGMP), resulting in prolongation of action of cGMP and therefore prolonged smooth muscle relaxation and vasodilation of smooth muscle. The mechanism behind the beneficial effect on IUGR was its vasodilator action and, hence, an increase in uteroplacental circulation. But the main issue during anaesthesia was fear of severe hypotension, ocular side effects, and bleeding due to the effect of sildenafil. which was expected in pregnant women taking Sildenafil for intrauterine growth retardation undergoing caesarean section. Severe hypotension was due to augmentation of hypotensive effect of sildenafil and regional anaesthesia. A 29-year-old female, previously healthy, non-smoking, at 33 weeks’ period of gestation presented with complaints of headache and pedal edema in third trimester and was diagnosed with gestational hypertension. On the 28th day of admission, she had episodes of elevated blood pressure. The patient was considered for emergency caesarean section after taking high-risk consent. Techniques for cesarean sections include the single shot spinal technique, epidural catheter technique, or the combined spinal-epidural technique (CSE). While spinal anaesthesia offers a simpler approach with a faster and more reliable onset of surgical anaesthesia, it may be associated with abrupt hemodynamic changes. On the contrary, epidural anaesthesia allows for a gradual onset of sympathectomy, titrated dosing, and postoperative analgesia. In this case, the decision was made to opt for epidural anaesthesia over spinal approach was made to allow for careful drug titration and enhance hemodynamic stability. We conclude that graded epidural epidural anaesthesia played an important role in the prevention of hypotension that was expected in pregnant women taking Sildenafil for intrauterine growth retardation undergoing caesarean section.

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1 Critical Care Innovations

1 2024

1 Kumar S.

1 Nayak S. S.

1 Yadav R.

1 Yadav U.

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Anaesthetic management of a pregnant women taking sildenafil for intra uterine growth retardation undergoing caesarean section: a case report