Remifentanil Target Controlled Infusion for conscious sedation in a pregnant woman: safety and efficacy

Abstract

\n Background: Every year 2% of pregnant women undergo non-obstetric surgical interventions worldwide. According to the American College of Obstetricians and Gynaecologists Committee on Obstetric Practice, pregnant women should never be denied the most appropriate surgical treatment regardless of the trimester of pregnancy.However, additional attention should be paid during the first trimester since there is the highest risk of inducing teratogenic mutations; similarly, during the third trimester, due to the possibility of preterm birth and low weight of the new-born great care should be paid.Case presentation: We present the case of a 36-year-old woman during her 21st week of pregnancy, with a normal-sized foetus according to the gestational age on ultrasound exam and with no additional risk factors. The patient referred an increasing nasal obstruction associated with rhinorrhoea of the left nasal cavity. She also reported episodes of sleep apnoea and hyposmia.The patient received a detailed otolaryngological examination which allowed to identify a mass within the left nasal cavity. The subsequent nasal endoscopy confirmed a greyish polypoid mass lesion with a multinodular surface occupying the entire left nasal fossa. The lesion totally obliterated the left maxillary sinus resulting in obstruction of the anterior osteo-meatal unit and ethmoidal sinusitis She was referred for functional endoscopic sinus surgery (FESS) using analgosedation with Remifentanil Target Controlled Infusion.Discussion and conclusions: To the very best of our knowledge this is the first case described in English literature about the use of analgosedation with Remifentanil Target Controlled Infusion for otolaryngology surgery, specifically in FESS. It could be an interesting option to avoid the use of inhaled anaesthetics that could induce foetal damage, especially during the first months of pregnancy. Furthermore, patient intubation is not necessary, avoiding cases of difficult intubation or any trauma to the airways. An adequate informed consent and the appropriate compliance are elements of paramount importance in tailoring the anaesthetic strategy for pregnant women who need non-obstetric surgical management.