Angioedema Following Spinal Anesthesia with Bupivacaine in a Pregnant Woman Undergoing Caesarian: A Case Report and Review of Potential Etiologies
Abstract
Spinal anesthesia with bupivacaine is widely used for cesarean sections but can rarely cause angioedema, a rapid swelling of deep tissues that may lead to airway obstruction. This case report presents the occurrence of angioedema in a pregnant woman with postoperative hyper IgE levels following spinal anesthesia. It highlights the intricate interplay between drug sensitivity, immune dysregulation, and the physiological changes associated with pregnancy. We present a case of a 32-year-old woman with post-operative hyper IgE levels who developed angioedema shortly after getting spinal anesthesia with bupivacaine for a cesarean section. It should be noted that the patient had no prior history of allergic reactions, making the case particularly interesting and challenging. This report's goal is to: 1. Report details of the clinical presentation, management, and outcome of this unusual patient; 2. Investigate the potential etiologies of angioedema, with a focus on the relationship between bupivacaine sensitivity, hyper IgE, and other possible factors; and 3. Highlight the challenges in diagnosis and management when facing angioedema in patients with atypical presentations.
[2] Volk T. [Complications of spinal anesthesia and how to avoid them]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2010;45(3):188-95.
[3] Misra L, Khurmi N, Trentman TL. Angioedema: Classification, management and emerging therapies for the perioperative physician. Indian J Anaesth. 2016;60(8):534-41.
[4] Pate MB, Smith JK, Chi DS, Krishnaswamy G. Regulation and dysregulation of immunoglobulin E: a molecular and clinical perspective. Clin Mol Allergy. 2010;8(1):3.
[5] Sinnathamby ES, Issa PP, Roberts L, Norwood H, Malone K, Vemulapalli H, et al. Hereditary Angioedema: Diagnosis, Clinical Implications, and Pathophysiology. Adv Ther. 2023;40(3):814-27.
[6] Cohen B, Glosser L, Saab R, Walters M, Salih A, Zafeer-Khan M, et al. Incidence of adverse events attributable to bupivacaine liposome injectable suspension or plain bupivacaine for postoperative pain in pediatric surgical patients: A retrospective matched cohort analysis. Paediatr Anaesth. 2019;29(2):169-74.
[7] Kalambay J, Ghazanfar H, Martes Pena KA, Munshi RA, Zhang G, Patel JY. Pathogenesis of Drug Induced Non-Allergic Angioedema: A Review of Unusual Etiologies. Cureus. 2017;9(8):e1598.
[8] Gangakhedkar GR, Kulkarni AP. Physiological Changes in Pregnancy. Indian J Crit Care Med. 2021;25(Suppl 3):S189-s92.
[9] Abu-Raya B, Michalski C, Sadarangani M, Lavoie PM. Maternal Immunological Adaptation During Normal Pregnancy. Front Immunol. 2020;11:575197.
[10] Chair, II, Binkley KE, Betschel SD. Hereditary Angioedema in Pregnancy. Obstet Gynecol Surv. 2021;76(9):566-74.
[11] Jackson CW, Pratt CM, Rupprecht CP, Pattanaik D, Krishnaswamy G. Mastocytosis and Mast Cell Activation Disorders: Clearing the Air. Int J Mol Sci. 2021;22(20).
[12] Caballero T, Farkas H, Bouillet L, Bowen T, Gompel A, Fagerberg C, et al. International consensus and practical guidelines on the gynecologic and obstetric management of female patients with hereditary angioedema caused by C1 inhibitor deficiency. J Allergy Clin Immunol. 2012;129(2):308-20.
[13] Betschel S, Badiou J, Binkley K, Borici-Mazi R, Hébert J, Kanani A, et al. The International/Canadian Hereditary Angioedema Guideline. Allergy Asthma Clin Immunol. 2019;15:72.
[14] Maurer M, Magerl M, Ansotegui I, Aygören-Pürsün E, Betschel S, Bork K, et al. The international WAO/EAACI guideline for the management of hereditary angioedema-The 2017 revision and update. Allergy. 2018;73(8):1575-96.
[15] Zeerleder S, Levi M. Hereditary and acquired C1-inhibitor-dependent angioedema: from pathophysiology to treatment. Ann Med. 2016;48(4):256-67.
[16] Valerieva A, Nedeva D, Yordanova V, Petkova E, Staevska M. Therapeutic management of hereditary angioedema: past, present, and future. Balkan Med J. 2021;38(2):89-103.
[17] Smolinska S, Antolín-Amérigo D, Popescu FD. Bradykinin Metabolism and Drug-Induced Angioedema. Int J Mol Sci. 2023;24(14).
[18] Macy E. Practical Management of New-Onset Urticaria and Angioedema Presenting in Primary Care, Urgent Care, and the Emergency Department. Perm J. 2021;25.
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| Angioedema Spinal Anesthesia Bupivacaine Hypersensitivity Pregnancy | ||
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