Anesthetic Management in First Trimester Pregnant Patient Undergoing Humerus and Pelvic ORIF

Abstract

ABSTRACT

Background: Non-obstetric surgery during pregnancy, particularly in the first trimester, presents complex clinical challenges regarding organogenesis risks, maternal oxygenation optimization, and maintenance of uteroplacental perfusion.

Objective: To evaluate the general anesthetic management in a first-trimester pregnant patient undergoing Open Reduction and Internal Fixation (ORIF) of the humerus and pelvis following severe orthopedic trauma.

Methods: A case report of a 25-year-old female, G1P0A0 at 11–12 weeks of gestation, diagnosed with closed left midshaft humerus fracture, closed left superior and inferior pubic rami fractures, and closed degloving of the abdominopelvic region following a motor vehicle accident. The patient underwent humerus and pelvic ORIF under general anesthesia with endotracheal intubation (kinked ETT No. 7.0).

Results: Anesthesia induction utilized Fentanyl 100 mcg, Propofol 100 mg, and Rocuronium 30 mg. Maintenance was achieved using Sevoflurane 2 vol% in O2:Air (50:50) at 2 LPM flow. Intraoperative hemodynamics remained stable (BP 115-125/68-77 mmHg, HR 78-87 bpm, SpO2 98-99%). Intraoperative blood loss was 400 cc (below Allowed Blood Loss of 468 cc), managed with 2,000 cc crystalloids and urine output of 300 cc. Pre- and postoperative fetal heart rate (FHR) monitoring confirmed a viable single fetus (FHR 134 bpm).

Conclusion: General anesthesia with endotracheal intubation, adequate preoxygenation, precise hemodynamic control, hemorrhage anticipation, and close fetal monitoring proved safe and effective for both mother and fetus in major first-trimester orthopedic surgery.

Keywords: First-trimester pregnancy; general anesthesia; humerus ORIF; pelvic fracture; uteroplacental perfusion.