General Anesthesia for Open Reduction and Internal Fixation of a Mandibular Fracture in a Woman with Epilepsy

<p>  In non-obstetric surgeries on pregnant women, the health of the fetus must be evaluated and managed in addition to ensuring maternal safety. Controlling seizures is of particular importance for pregnant patients with epilepsy, as seizures could suppress respiration and lead the fetus experiencing hypoxia.</p><p>  We performed general anesthesia in a 32-year-old woman with epilepsy ; at the time, the patient was in her 26th week of pregnancy. An obstetrician confirmed the health of the pregnant woman and the fetus. A neurologist suggested that the patient’s serum level of carbamazepine might be reduced because of fatigue and emotional stress, which could lead to an epileptic seizure. Consequently, the patient’s serum level of carbamazepine was measured on the morning of the surgery. Anesthesia was rapidly induced using fentanyl, propofol, and rocuronium. The patient was intubated using a fiberscope, as she had a restricted mouth opening. Anesthesia was maintained with desflurane and remifentanil. The fetal heartbeat was periodically checked intraoperatively using fetal ultrasound cardiography. The fetal heart rate was stable at 135–139 beats per minute, and no bradycardia was noted. The operation was completed without any problems, and the patient had a good respiratory condition after extubation. Both the mother and the fetus subsequently progressed uneventfully, and the baby was born by normal vaginal delivery ; no morphological or functional abnormalities were found. When performing general anesthesia during pregnancies complicated by epilepsy, preventing seizures by collaborating with a neurologist is important.</p><p>  Working in collaboration with the obstetrician/gynecologist to perform appropriate fetal monitoring appropriate for the number of weeks of pregnancy is also important.</p>