A parturient with congenital methemoglobinemia: navigating the oxygen saturation gap
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20262573Keywords:
Congenital methemoglobinemia, Oxygen saturation gap, Co-oximetryAbstract
Congenital methemoglobinemia (CMH) presents unique anesthetic challenges due to oxidative stress risks. We report a primigravida with type 1 CMH presenting with a profound oxygen saturation gap. Labor analgesia was successfully managed using a continuous epidural infusion of ultra-low dose bupivacaine (0.0625%) and fentanyl. The protocol strictly mandated avoiding oxidizing agents, notably substituting lidocaine with epidural bupivacaine for perineal repair. The patient was hemodynamically stable and delivered a healthy neonate. This case validates ultra-low dose epidural bupivacaine as a safe, effective strategy for labor analgesia in CMH, minimizing systemic drug load and oxidative risks.
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