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///2015 Abstract Details
2015 Abstract Details2019-08-02T16:54:43-05:00

Management of a patient Goldenhar syndrome,difficult airway, placenta accreta and intra-operative hypotesion secondary to cell salvage blood

Abstract Number: S-62
Abstract Type: Case Report/Case Series

Neil A Logan MBCHB, BSc (Hons), FRCA1 ; Claire Barker MBCHB, FRCA2; Young Stephen MBCHB, FRCA3; McGrady Elizabeth MBCHB, FRCA4

Background:Goldenhar syndrome,also known as oculo-

auricular vertebral dysplasia,first described in 1952,is

a rare congenital abnormaility characterised by unilateral

incomplete development of the ear, nose, soft palate and

mandible.When these occur with spinal abnormalities it is

known as Goldenhar syndrome.Treatment is usually confined

to surgical interventions to help the child develop.

Case:28 year old para 2+0,2 previous caesarean sections(CS)

under spinal anaesthesia,with Goldenhar syndrome was

diagnosed with probable placenta accreta on ultrasound.She

was unable to have an MRI due to the presence of extensive

spinal metalwork.Airway examination revealed marked facial

asymmetry,mallampati grade2,receding jaw and limited neck

extension.The decision was made to

perform an elective CS at 35 weeks under a general

anaesthetic.Her blood tests were unremarkable.

Interventional radiology inserted bilateral iliac balloons under

local anaesthetic prior to incision.Her airway was secured with

an awake fibreoptic intubation and then she was induced with

propofol 200mg.A radial arterial line was inserted and cell

salvage was available. Visual inspection of the uterus revealed

placental invasion through the uterine wall but not into any

adjacent structures.A live baby boy was delivered through a

vertical uterine incision. Due to the fixation of the placenta it

was decided to perform a hysterectomy.Blood loss was

1500ml in total and we returned 600ml via cell salvage.Twice

during this the patient experienced profound hypotension

which resolved with phenylephrine and stopping the infusion.See pic 1.

This has been reported previously in the literature(1) and is

thought to be due to the use of a leucocyte depletion filter.

We performed bilateral TAP blocks prior to emergence and

provided a morphine PCA.Post-operatively the patient went

to the obstetric HDU and made a good recovery.

Discussion:This patient provided a number of anaesthetic

and obstetric challenges. Her care mandated the involvement

of a multi-disciplinary team, which resulted in a good outcome

for both mother and child.This case highlights the benefits of

effective multi-disciplinary care.Furthermore, it also illustrated

the potential hypotensive response to cell salvage auto-

transfusion via a leucocyte depletion filter.

References

1.Waldron S.Hypotension associated with leucocyte depletion filters

following cell salvage in obstetrics.Anaesthesia,vol 66,issue

2,2011,133 -134



SOAP 2015