Total Intravenous Anesthesia Using Target-Controlled Infusion with Propofol for Category 1 Emergency Cesarean Section in Patients with Preeclampsia with Severe Features
Abstract
1. Introduction
- New-onset hypertension that occurs most often after 20 weeks of gestation and frequently near term. Blood pressure of ≥140 mm Hg systolic or ≥90 mm Hg diastolic on two occasions at least 4 h apart.
- Proteinuria, which is usually present but not mandatory for diagnosis.
2. Case Series Presentation
- The patient positioning in a left lateral tilt.
- Establishing two peripheral intravenous lines.
- Initiation of crystalloid administration with approximately 500 mL of Ringer’s solution.
- Oxygen administration via face mask, 5–6 L/min, as part of the preoxygenation process.
- Prokinetic administration: metoclopramid 10 mg intravenous (IV).
- Continuous monitoring included heart rate via ECG monitoring, oxygen saturation, and noninvasive blood pressure.
- Insertion of urinary catheter.
- Surgical preparation and draping were performed before induction.
- Sufentanyl (10 mcg) was administered before propofol initiation.
- Initial TCI target plasma concentration (Cpt) was set at 7–8 mcg/mL to rapidly increase the effect-site concentration (Ce).
- As the Ce increased to 3 mcg/mL, rocuronium was administered at a dose of 1–1.2 mg/kg.
- Orotracheal intubation at Ce 3.5 mcg/mL, using a C-MAC videolaryngoscope blade (Storz C-MAC 8403 ZX, Karl Storz SE & Co. KG, Tuttingen, Germany), and using a 7.0 mm endotracheal tube fixed at 20–21 cm. During intubation, bag-mask ventilation was omitted, and Sellick’s maneuver was not performed.
- After intubation, Cpt was reduced to 4 mcg/mL.
- After intubation, a nasogastric tube was placed, and gastric contents were aspirated.
- Pfannenstiel incision was made as soon as the cuff passed through the vocal cords and was inflated.
- Anesthesia was maintained at a Ce of 4 mcg/mL.
- Sufentanil’s second dose (10 mcg) was administered after delivery, and third dose as needed.
- Target-controlled infusion of propofol was stopped (Cpt set to 0 mcg/mL) upon completion of wound closure.
- Plasma concentration and effect-site concentration were monitored continuously until extubation.
- Neuromuscular blockade was reversed with sugammadex 100–200 mg IV.
- Extubation: During emergence, external stimulation was avoided, and extubation was performed following spontaneous eye opening, consistent with awake extubation practices as recommended by the DAS Extubation Guidelines [17].
- For analgesia, the patient received intravenous paracetamol 1 g, ibuprofen 300 mg, metamizole 1 g, and tramadol 100 mg, along with granisetron 1 mg administered as an antiemetic, on extubation.
- No Train-of-Four (TOF) monitoring or depth of anesthesia assessment using Bispectral Index (BIS) or Entropy was performed during the intervention, primarily due to the lack of routine availability of these monitoring modalities.
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Entering OR + Monitor, Draping | TCI Start | Rocuronium Adm. | OTI + Incision | Delivery | Stop Propofol Infusion | Extubation | Total | |
---|---|---|---|---|---|---|---|---|
Time | 12:40 | 12:47 | 12:49 | 12:50 | 12:59 | 13:33 | 13:53 | |
Cpt (μg/mL) | 0 | 8 | 8 | 8 | 4 | 4 | 1.7 | |
Ce (μg/mL) | 0 | 0 | 3 | 3.5 | 4 | 4 | 1.93 | |
Propofol (mg) | 0 | 248 | 277 (from start) | 696 | 0 | 973 | ||
Rocuronim (mg) | 100 | 100 | ||||||
Sufentanil (µg) | 10 | 10 | 20 | |||||
BP (mmHg) | 182/99 | 180/95 | 170/104 | 160/97 | 145/83 | 140/80 | 138/75 | |
MAP (mmHg) | 126 | 123 | 126 | 118 | 105 | 102 | 96 | |
SpO2 (%) | 99 | 99 | 98 | 99 | 99 | 99 | 98 | |
HR (/min) | 90 | 93 | 100 | 115 | 98 | 90 | 75 | |
Urine output (mL) | 300 | |||||||
Fluids (mL) | 600 | |||||||
E.Blood loss (mL) | 900 | |||||||
Oxytocin (U.I.) | 5 + 10 continuous infusion | 15 * |
Entering OR + Monitor, Draping | TCI Start | Rocuronium Adm. | OTI + Incision | Delivery | Stop Propofol Infusion | Extubation | Total | |
---|---|---|---|---|---|---|---|---|
Time | 11:35 | 11:40 | 11:42 | 11:43 | 11:46 | 12:22 | 12:38 | |
Cpt (μg/mL) | 0 | 7 | 7 | 7 | 4 | 4 | 1.3 | |
Ce (μg/mL) | 0 | 0 | 3 | 3.5 | 4 | 4 | 1.5 | |
Propofol (mg) | 0 | 243 | 266 (from start) | 773 | 0 | 1039 | ||
Rocuronium (mg) | 100 | 100 | ||||||
Sufentanil (mcg) | 10 | 10 + 10 | 30 | |||||
BP (mmHg) | 210/130 | 197/119 | 180/105 | 169/118 | 141/82 | 120/65 | 140/90 | |
MAP (mmHg) | 157 | 145 | 130 | 135 | 102 | 83 | 107 | |
SpO2 (%) | 99 | 98 | 98 | 99 | 98 | 99 | 99 | |
HR (/min) | 120 | 117 | 120 | 128 | 85 | 90 | 80 | |
Urine output (mL) | 200 | |||||||
Fluids (mL) | 1000 | |||||||
E.Blood loss (mL) | 600 | |||||||
Oxytocin (U.I) | 5 + 10 continuous infusion | 15 * |
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Szederjesi, J.; Almasy, E.; Branea, O.E.; Keresztes, M. Total Intravenous Anesthesia Using Target-Controlled Infusion with Propofol for Category 1 Emergency Cesarean Section in Patients with Preeclampsia with Severe Features. Life 2025, 15, 1237. https://doi.org/10.3390/life15081237
Szederjesi J, Almasy E, Branea OE, Keresztes M. Total Intravenous Anesthesia Using Target-Controlled Infusion with Propofol for Category 1 Emergency Cesarean Section in Patients with Preeclampsia with Severe Features. Life. 2025; 15(8):1237. https://doi.org/10.3390/life15081237
Chicago/Turabian StyleSzederjesi, Janos, Emoke Almasy, Oana Elena Branea, and Matild Keresztes. 2025. "Total Intravenous Anesthesia Using Target-Controlled Infusion with Propofol for Category 1 Emergency Cesarean Section in Patients with Preeclampsia with Severe Features" Life 15, no. 8: 1237. https://doi.org/10.3390/life15081237
APA StyleSzederjesi, J., Almasy, E., Branea, O. E., & Keresztes, M. (2025). Total Intravenous Anesthesia Using Target-Controlled Infusion with Propofol for Category 1 Emergency Cesarean Section in Patients with Preeclampsia with Severe Features. Life, 15(8), 1237. https://doi.org/10.3390/life15081237