Anesthetic Management of a Pregnant Woman with Heroin Addiction Under Emergency Conditions: A Case Report
Heroin abuse and addiction is steadily increasing worldwide, particularly among young people and pregnant women. In the current report, we present the challenges encountered in the management of a pregnant patient with heroin dependence in the pre- and intraoperative stages and discuss the choice of anesthetic technique under emergency circumstances. We performed an emergency cesarean section (C/S) under spinal anesthesia in a 23-year-old pregnant woman who presented with fetal distress and who had a history of heroin abuse during pregnancy. After delivery, 1 mg midazolam and 50 μg fentanyl were administered to relieve maternal anxiety. We recommend the use of regional anesthesia, if not contraindicated, in pregnant women with opioid dependence requiring emergency C/S. Keywords: Anesthetic managament, caesarean, heroin addiction.
1. Lindsay MK, Burnett E. The use of narcotics and street drugs during pregnancy. Clin Obstet Gynecol 2013;56:133–41.
2. Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology 2014;121:1158–65. [CrossRef]
3. Minozzi S, Amato L, Vecchi S, Davoli M. Maintenance agonist treatments for opiate dependent pregnant women. Cochrane Database Syst Rev 2008:CD006318. [CrossRef]
4. Keegan J, Parva M, Finnegan M, Gerson A, Belden M. Addiction in pregnancy. J Addict Dis 2010;29:175–91. [CrossRef]
5. Koppel BS, Tuchman AJ, Mangiardi JR, Daras M, Weitzner I. Epidural spinal infection in intravenous drug abusers. Arch Neurol 1988;45:1331–7. [CrossRef]
6. Weintraub SJ, Naulty JS. Acute abstinence syndrome after epidural injection of butorphanol. Anesth Analg 1985;64:452–3.
7. Wood PR, Soni N. Anaesthesia and substance abuse. Anaesthesia 1989;44:672–80. [CrossRef]
8. May JA, White HC, Leonard-White A, Warltier DC, Pagel PS. The patient recovering from alcohol or drug addiction: special issues for the anesthesiologist. Anesth Analg 2001;92:1601–8.
9. Pasero CL, Compton P. Managing pain in addicted patients. Am J Nurs 1997;97:17–8. [CrossRef]
10. Mitra S, Sinatra RS. Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology 2004;101:212– 27. [CrossRef]