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Anesthetic Management of A Patient who Underwent Emergent Cesarean Section after Sudden Disturbance of Consciousness Caused by Disseminated Intravascular Coagulation due to Severe Urine Infection and Septic Shock

Yuya Sato, Shinsuke Hamaguchi, Yuki Numata, Makoto Komatsuzaki and Yusuke Yamashita

A 29-year-old woman with a history of lower back pain presented at 38 weeks of normal gestation with sudden headache and progressive disturbance of consciousness. Laboratory findings suggested severe infection, and detailed examination was necessary to determine the cause. However, the fetal heart rate suddenly decreased to <60 bpm. Therefore, emergent caesarian section was performed. Because of hypersomnia and fetal bradycardia, we decided to perform surgery under general anesthesia, which was induced with 5 mg/kg thiamylal and 0.8 mg/kg rocuronium in rapid sequence. Oxygen–nitrous oxide inhalation was used for maintenance of anesthesia until delivery. The infant’s Apgar score was 2/5/6. Immediately after delivery, we administered 30 mg pentazocine and 5 mg diazepam. However, this triggered a sudden drop in the patient’s blood pressure. Phenylephrine and dopamine were administered to increase her blood pressure. Furthermore, oozing from the surgical field was observed during abdominal closure, and bleeding from the abdominal drain and oozing from the scar increased in the intensive care unit. Her plasma fibrinogen level had decreased to <50 mg/dl from the preoperative level of 530 mg/dl. On the basis of her medical history of right pyelonephritis and sonographic findings of bilateral renal pelvis expansion, a diagnosis of disseminated intravascular coagulation caused by urine infection and severe septic shock was made. Her conditions showed marked improvement after appropriate treatment with fresh frozen plasma and a third-generation cephalosporin.