///2014 Abstract Details
2014 Abstract Details2019-07-18T14:34:47-06:00

Use of Nitrous Oxide/Oxygen Mixer in a Thrombocytopenic Parturient

Abstract Number: S-64
Abstract Type: Case Report/Case Series

Amit H Doshi MD, MS1 ; Helene Finegold MD2

Administration of N2O/O2 mixture for labor analgesia is a practice in many European countries, but seldom used in the United States. In this case report, we discuss successful administration of nitrous oxide in a thrombocytopenic parturient who would otherwise be a poor candidate for neuraxial analgesia. The patient is a 36 year old Gravida 2 Para 1 at 39 1/7 weeks gestational age confirmed by ultrasound and presence of fetal heart tones, who presented for scheduled induction of labor. She had a past medical history significant for systemic lupus erythematosus with associated thrombocytopenia, advanced maternal age, and asthma. In her first pregnancy, there was concern for preeclampsia with HELLP and the patient was diagnosed with SLE. She had previously had a SVD to VMI complicated by shoulder dystoscia and postpartum hemorrhage requiring manual extraction of the placenta. The patient was subsequently placed on hydroxychloroquine. The patient’s platelet count had been showing a declining trend during her pregnancy from 125,000/mmol during her first trimester to the time of presentation, which was 53,000/mmol. While platelets were being prepared for transfusion, patient started feeling increasingly uncomfortable with contractions and the decision was made to offer the patient SEDARA Gas Mixer System. SEDARA offers a 50/50 mixture of oxygen and nitrous oxide delivered under patient control via negative inspiratory pressures. Patient received 45 minutes of administration of N2O/O2 and delivered with minimal discomfort and no other medications. During the administration of N2O, patient’s blood pressures ranged from 105-145/45-80 with heart rates ranging from 72-110. Delivery of infant was without complication, APGAR scores were 8 at one minute and 9 at five minutes. Vital signs of the infant upon delivery were heart rate 160, temperature 37.1, respiratory rate 48, blood pressure 70/39 and pulse oximetry 98% on room air. Post-delivery, the patient had a second degree perineal tear which was repaired while the patient continued to use Sedara, and 15 mL of lidocaine 1% administered by the surgeon at the site of the injury. Patient had no postoperative complications and the infant was watched in neonatal ICU because of maternal thrombocytopenia. With the increasing availability of nitrous oxide mixing systems in the US, non-neuraxial options for analgesic relief during labor should be considered.

SOAP 2014