///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-06:00

Trousseau's Sign in a Parturient During Labor Which Subsided after Epidural Analgesia

Abstract Number: 96
Abstract Type: Case Report/Case Series

James R. Dyer MD1

Case Report: A 21 yo G1P0 term parturient was admitted to labor and delivery for induction of labor. She described no past medical or surgical problems, her pregnancy was uncomplicated and she took no medications. Once in active labor she requested epidural analgesia. During contractions she hyperventilated vigorously and had carpal spasm during and after inflation of the non-invasive blood pressure cuff (Trousseaus sign). Serum chemistry studies included calcium 9.1 mg/dl (8.6-10.0), postassium 3.8 mEQ/L (3.5-5.1), and magnesium 1.7mg/dl (1.6-2.6). She received a labor epidural which provided excellent analgesia. Despite occurring many times prior to epidural placement, carpal spasm stopped after effective analgesia was achieved. The remainder of her labor and delivery was uncomplicated.

Discussion: Tetany due to hyperventilation during labor has been described in at least four other case reports. In 1982, Argent described the treatment of tetany due to hyperventilation during labor with nitrous oxide, oxygen, and carbon dioxide (1). In 1994, Burden described a parturient that became unconscious due to hyperventilation who regained consciousness after labor epidural analgesia (2). In 2004, Craig and Panni reported the treatment of hyperventilation induced transient spastic quadriparesis with rebreathing of carbon dioxide and intravenous fentanyl (3). In 2005, Ray and Camann described a parturient with hyperventilation induced tetany associated with epidural analgesia. Although the patients tetany continued after epidural placement, so did her hyperventilation with painful contractions due to inadequate analgesia. After supplemental local anesthetic and fentanyl was given via an epidural bolus, effective analgesia was obtained and the tetany subsided (4), as it did in our patient.

Hyperventilation causes hypocalcemia by increasing calcium binding to albumin and by the movement of calcium ions intracellularly. Hypomagnesiumemia and hypokalemia may also cause tetany. Calcium, magnesium, and potassium levels were normal in our patient, as in Burdens patient (2), but were decreased in other reports (4). It is unknown whether the time of blood collection relative to the period of hyperventilation (and uterine contractions) affects free serum calcium levels.

Since our patients carpal spasm occurred many times prior to epidural analgesia and subsided after effective epidural analgesia, it is likely that the tetany occurred as a result of hyperventilation from painful contractions and transient hypocalcemia. Although rebreathing carbon dioxide and intravenous and epidural fentanyl have been described as treatments (1,3-4), epidural analgesia is also effective. It is reassuring that all the reported cases had favorable outcomes.

References: 1. Br Med J 1982 Jul10;28(6335):117-8.

2. Br J Anes 1994 73: 838-839.

3. Br J Anes 2004 93(3): 474-475.

4. IJOA 2005 14(1): 74-76.

SOAP 2009