A pregnant woman with placenta pre staed to bleed as she went into labor. Her blood pressure was 80/50 mm Hg. A lower segment caesarean section was planned in view of acute shock. What type of anesthesia will you plan for this patient?
(A) General anesthesia with IV induction by ketamine (B) Spinal anesthesia up to L4 level (C) General anesthesia with IV induction by propofol followed by maintenance with fluranes (D) Sedation and epidural analgesia
(A) Ans: A. General anesthesia with IV induction by ketamine(Ref Williams 24/e p516; Morgan 4/e p197-199)This patient of placenta pre is in labor and has bled into shock.She should be delivered by cesarean section under general anesthesia.General anesthesia is preferred as it is a more controllable modality and there is a significant risk of hypotension associated with spinal anesthesia.Ketamine is the preferred agent in cases of acute shock.Stimulates sympathetic system causing tachycardia and hypeension, so it is intravenous anaesthetic of choice for shock.