Combined general-epidural anesthesia for cesarean section in acute fatty liver of pregnancy under monitoring bispectral index: A case report

Kim, Seong Hyop; Kim, Jee Young; Jeong, Seung Min; Sung, Tae Yun; Lim, Jeong Ae; Woo, Nam Sik

Case Report

Obstetric Anesthesia

Anesthesia and Pain Medicine 2010;5(2):155-158.
Published online April 30, 2010.

Combined general-epidural anesthesia for cesarean section in acute fatty liver of pregnancy under monitoring bispectral index: A case report

Seong Hyop Kim, Jee Young Kim, Seung Min Jeong, Tae Yun Sung, Jeong Ae Lim, Nam Sik Woo

Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea. nswoo@kuh.ac.kr

Abstract

Acute fatty liver of pregnancy is a rare but usually fatal complication of the third trimester. We report the case of a 28-year-old primigravida at 37 weeks of gestation with an acute fatty liver. Continuous fetal heart rate monitoring demonstrated frequent late fetal heart decelerations and the lack of beat-to-beat variability during the induction of vaginal delivery. We decided to perform an emergency cesarean section under a combined general-epidural anesthesia with bispectral index. No complications occurred during or after surgery except for a delayed recovery from the muscle relaxant. The patient made an uneventful recovery and discharged at eight days after cesarean section.

Key Words: Acute fatty liver of pregnancy, Bispectral index, Cesarean section, Combined general-epidural anesthesia