Skip to main content

Anesthesia for Pregnant Patient with Psychiatric Disorders

  • Chapter
  • First Online:
Obstetric Anesthesia for Co-morbid Conditions
  • 580 Accesses

Abstract

The increasing number of women with perinatal mental illness has been requiring obstetric anesthesia care. These disorders include mood, anxiety, psychotic, substance use, eating, and personality disorders. Preoperative evaluation of the patients with known or suspected psychiatric disease should be adjusted according to the type and severity of the mental disorder. The patients with stable mental status should be encouraged to have regional anesthesia due to well-known benefits of techniques during obstetric anesthesia. Yet, the choice of anesthetic technique should actively be depended on the mental status of the patient, and postoperative care should be attentively managed regarding pain relief and continuation of medical therapy for the psychiatric disease. The purpose of this chapter is to summarize perinatal psychiatric illnesses and to detail their implications on obstetric anesthesia regarding the main issues mentioned above.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Reide PJW, Yentis SM. Anaesthesia for the obstetric patient with (non-obstetric) systemic disease. Best Pract Res Clin Obstet Gynaecol. 2010;24:313–26. http://linkinghub.elsevier.com/retrieve/pii/S1521693409001515.

    Article  Google Scholar 

  2. Oates M. Suicide: the leading cause of maternal death. Br J Psychiatry. 2003;183:279–81.

    Article  Google Scholar 

  3. O’Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014;28:3–12.

    Article  Google Scholar 

  4. Paschetta E, Berrisford G, Coccia F, Whitmore J, Wood AG, Pretlove S, et al. Perinatal psychiatric disorders: an overview. Am J Obstet Gynecol. 2014;210:501–U258.

    Article  Google Scholar 

  5. Stuart S, Couser G, Schilder K, O’Hara MW, Gorman L. Postpartum anxiety and depression: onset and comorbidity in a community sample. J Nerv Ment Dis. 1998;186:420–4.

    Article  CAS  Google Scholar 

  6. Munk-Olsen T, Laursen TM, Meltzer-Brody S, Mortensen PB, Jones I. Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders. Arch Gen Psychiatry. 2012;69:428–34. http://archpsyc.jamanetwork.com/article.aspx?doi=10.1001/archgenpsychiatry.2011.157.

    Article  Google Scholar 

  7. Hudak R, Wisner KL. Diagnosis and treatment of postpartum obsessions and compulsions that involve infant harm. Am J Psychiatry. 2012;169:360–3. http://psychiatryonline.org/doi/abs/10.1176/appi.ajp.2011.11050667.

    Article  Google Scholar 

  8. Grof P, Robbins W, Alda M, Berghoefer A, Vojtechovsky M, Nilsson A, et al. Protective effect of pregnancy in women with lithium-responsive bipolar disorder. J Affect Disord. 2000;61:31–9. http://www.ncbi.nlm.nih.gov/pubmed/11099738.

    Article  CAS  Google Scholar 

  9. Kuczkowski KM. Labor analgesia for the tobacco and ethanol abusing pregnant patient: a routine management? Arch Gynecol Obstet. 2005;271:6–10.

    Article  Google Scholar 

  10. Ashley OS, Marsden ME, Brady TM. Effectiveness of substance abuse treatment programming for women: a review. Am J Drug Alcohol Abuse. 2003;29:19–53. http://www.ncbi.nlm.nih.gov/pubmed/12731680.

    Article  Google Scholar 

  11. Ludlow J, Christmas T, Paech MJ, Orr B. Drug abuse and dependency during pregnancy: anaesthetic issues. Anaesth Intensive Care. 2007;35:881–93.

    CAS  PubMed  Google Scholar 

  12. Bulbul F, Copoglu US, Alpak G, Unal A, Demir B, Tastan MF, et al. Electroconvulsive therapy in pregnant patients. Gen Hosp Psychiatry. 2013;35:636–9.

    Article  Google Scholar 

  13. McCullough LB, Chervenak FA, Coverdale JH. Managing care of an intrapartum patient with agitation and psychosis: ethical and legal implications. AMA J Ethics. 2016;18:209–14.

    Article  Google Scholar 

  14. Sener EB, Kocamanoglu S, Ustun E, Tur A. Anesthetic management for cesarean delivery in a woman with Gilles de la Tourette’s syndrome. Int J Obstet Anesth. 2006;15:163–5.

    Article  CAS  Google Scholar 

  15. Vermersch C, Smadja S, Amselem O, Gay O, Marcellin L, Gaillard R, et al. Cesarean section and sismotherapy in a severe psychotic parturient: a case report. Ann Fr Anesth Reanim. 2013;32:711–4.

    Article  CAS  Google Scholar 

  16. McAllister N, Elshtewi M, Badr L, Russell IF, Lindow SW. Pregnancy outcomes in women with severe needle phobia. Eur J Obstet Gynecol Reprod Biol. 2012;162:149–52.

    Article  CAS  Google Scholar 

  17. Hillermann T, Breitenstein C, Soll C. Kasuistik: Patientin mit Nadelphobie zur Sectio caesarea – Nicht ganz wie im Lehrbuch. Anasthesiol Intensivmed Notfallmed Schmerzther. 2015;50:388–91.

    Article  Google Scholar 

  18. Nakanishi R, Nishimura S, Kimura M, Miyazaki Y, Hamada T, Mori T. Cesarean section in a morbidly obese parturient with borderline personality disorder under combined spinal and epidural anesthesia. Masui. 2008;57:628–30.

    PubMed  Google Scholar 

  19. Xu Y, Li Y, Huang X, Chen D, She B, Ma D. Single bolus low-dose of ketamine does not prevent postpartum depression: a randomized, double-blind, placebo-controlled, prospective clinical trial. Arch Gynecol Obstet. 2017;295:1167–74.

    Article  CAS  Google Scholar 

  20. Wakil L, Perea E, Penaskovic K, Stuebe A, Meltzer-Brody S. Exacerbation of psychotic disorder during pregnancy in the context of medication discontinuation. Psychosomatics. 2013;54:290–3.

    Article  Google Scholar 

  21. Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013;13:533–40. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3865832&tool=pmcentrez&rendertype=abstract.

    PubMed  PubMed Central  Google Scholar 

  22. Williams JH, Hepner DL. Risperidone and exaggerated hypotension during a spinal anesthetic. Anesth Analg. 2004;98:240–1.

    Article  Google Scholar 

  23. Blake LD, Lucas DN, Aziz K, Castello-Cortes A, Robinson PN. Lithium toxicity and the parturient: case report and literature review. Int J Obstet Anesth. 2008;17:164–9.

    Article  CAS  Google Scholar 

  24. Jones HE, Deppen K, Hudak ML, Leffert L, McClelland C, Sahin L, et al. Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers. Am J Obstet Gynecol. 2014;210:302–10. http://linkinghub.elsevier.com/retrieve/pii/S0002937813010582.

    Article  Google Scholar 

  25. Jones HE, Heil SH, Baewert A, Arria AM, Kaltenbach K, Martin PR, et al. Buprenorphine treatment of opioid-dependent pregnant women: a comprehensive review. Addiction. 2012;107:5–27.

    Article  Google Scholar 

  26. Loures V, Savoldelli GL, Alberque C, Haller G. Post-dural puncture cerebrospinal fluid leak presenting as an acute psychiatric illness. Br J Anaesth. 2012;108:529–30.

    Article  CAS  Google Scholar 

  27. Campbell DA, Varma TRK. Chronic subdural haematoma following epidural anaesthesia, presenting as puerperal psychosis. BJOG. 1993;100:782–4.

    Article  CAS  Google Scholar 

  28. Clunie M, Crone L-A, Klassen L, Yip R. Psychiatric side effects of indomethacin in parturients. Can J Anaesth. 2003;50:586–8.

    Article  Google Scholar 

  29. Suhitharan T, Pham TPT, Chen H, Assam PN, Sultana R, Han NLR, et al. Investigating analgesic and psychological factors associated with risk of postpartum depression development: a case-control study. Neuropsychiatr Dis Treat. 2016;12:1333–9.

    PubMed  PubMed Central  Google Scholar 

  30. Cassidy B, Cyna AM. Challenges that opioid-dependent women present to the obstetric anaesthetist. Anaesth Intensive Care. 2004;32:494–501.

    CAS  PubMed  Google Scholar 

  31. Frayne J, Lewis L, Allen S, Hauck Y, Nguyen T. Severe mental illness and induction of labour: outcomes for women at a specialist antenatal clinic in Western Australia. Aust N Z J Obstet Gynaecol. 2014;54:132–7.

    Article  Google Scholar 

  32. Franko DL, Blais MA, Becker AE, Delinsky SS, Greenwood DN, Flores AT, et al. Pregnancy complications and neonatal outcomes in women with eating disorders. Am J Psychiatry. 2001;158:1461–6.

    Article  CAS  Google Scholar 

  33. Birnbach DJ, Bourlier RA, Choi R, Thys DM. Anaesthetic management of caesarean section in a patient with active recurrent genital herpes and AIDS-related dementia. Br J Anaesth. 1995;75:639–41.

    Article  CAS  Google Scholar 

  34. Soltanifar S, Russell R. Neuraxial anaesthesia for caesarean section in a patient with narcolepsy and cataplexy. Int J Obstet Anesth. 2010;19:440–3.

    Article  CAS  Google Scholar 

  35. Ozgul U, Erdogan MA, Sanli M, Erdil F, Begec Z, Durmus M. Anaesthetic management in electroconvulsive therapy during early pregnancy. Turk J Anaesthesiol Reanim. 2014;42:145–7.

    Article  Google Scholar 

  36. Bakı ED, Akıcı ÖÇ, Güzel Hİ, Kokulu S, Ela Y, Sıvacı RG. Nossa experiência em anestesia durante terapia eletroconvulsiva em pacientes grávidas. Braz J Anesthesiol. 2016;66:555.

    Article  Google Scholar 

  37. Balki M, Castro C, Ananthanarayan C. Status epilepticus after electroconvulsive therapy in a pregnant patient. Int J Obstet Anesth. 2006;15:325–8.

    Article  CAS  Google Scholar 

  38. Ivascu Brown N, Fogarty Mack P, Mitera DM, Dhar P. Use of the ProSeal™ laryngeal mask airway in a pregnant patient with a difficult airway during electroconvulsive therapy. Br J Anaesth. 2003;91:752–4.

    Article  Google Scholar 

  39. Rabheru K. The use of electroconvulsive therapy in special patient populations. Can J Psychiatr. 2001;46:710–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Yalcin Cok, O. (2018). Anesthesia for Pregnant Patient with Psychiatric Disorders. In: Gunaydin, B., Ismail, S. (eds) Obstetric Anesthesia for Co-morbid Conditions. Springer, Cham. https://doi.org/10.1007/978-3-319-93163-0_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-93163-0_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-93162-3

  • Online ISBN: 978-3-319-93163-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics