Anesthetic Dilemma in a Full-term Parturient with Facial Trauma and Suspected Head Injury Presenting as Difficult Airway Posted for Emergency LSCS in a Limited Resource Setting: Spinal versus General Anesthesia

Trauma frequently occurs during pregnancy and occurs 1 in 12 pregnant women affecting maternal mortality, morbidity, and also pregnancy outcome. Hence, it is essential to consider pregnancy in every female trauma patient of reproductive age. Motor vehicle accidents and domestic/intimate partner violence account for most cases of major maternal trauma. Most of the causes mentioned above can lead to facial injuries/head injuries making it challenging for the anesthesia provider. We report a parturient who presented to us with multiple facial injuries with a suspected head injury following a road traffic accident with restricted mouth opening. The anesthesiologist is put in a dilemma to choose between general and regional anesthesia in such full-term parturients where patients present with suspected head injury anticipating increased intracranial pressure and at the same time are difficult airway posted for emergency C-section in a limited resource setting with no difficult airway gadgets. Management of full-term pregnant patients with major trauma presents unique challenges since the presence of a fetus means two patients are potentially at risk, both of whom require evaluation and management. An anesthetist has to evaluate the patient, assess the risks and benefits of both regional and general anesthesia, and plan perioperative care accordingly within a limited time. Management of such presentation needs a team approach of neurosurgeons, obstetricians, anesthesiologists, and pediatricians to have a smooth and safe conduction of delivery and care of the newborn postoperatively. The anesthetist plays an important role as a perioperative physician in such cases by taking adequate preoperative neuroprotective measures, choosing a near-ideal mode of anesthesia by weighing the risk-benefits of general versus regional anesthesia, and giving adequate postoperative monitoring and care.