- Review
- Open access
- Published:
Anesthetic approach to pregnant patients with malaria: a narrative review of the literature
Journal of Anesthesia, Analgesia and Critical Care volume 4, Article number: 48 (2024)
Abstract
Introduction
Anesthesiologists play an important role in the management of labor and delivery during acute malaria infection. The peripartum anesthesia considerations for such cases remain unclear.
Findings
Important peripartum considerations include the severity of thrombocytopenia and coagulopathy, hemodynamic status and cardiac disease, and the likelihood of central nervous system (CNS) involvement. Several antimalarial drugs may interact with perioperative medications, causing hypoglycemia, methemoglobinemia, or QT prolongation. Labor should usually not be induced. Patient volume status should be optimized pre-induction, but fluids should be administered with caution given the risk of cerebral edema. In case of CNS involvement intracranial pressure should be maintained. Case reports describe the successful use of neuraxial anesthesia but this approach requires further confirmation of safety. Despite the risks accompanying airway management in pregnancy, in some cases, general anesthesia was preferred due to the chance of CNS infection and disease complications. Tight postoperative assessments of neurological and bleeding status are indicated regardless of the mode of delivery.
Conclusions
Despite the prevalence of malaria, the perioperative risk and preferred mode of anesthesia for pregnant patients with acute malaria remain under-researched and outcome data are limited.
Background
Malaria, a disease caused by Plasmodium (P) species, accounts for approximately 250 million cases and 600 thousand deaths annually globally [1]. Severe malaria is usually associated with high parasite loads, and hyperparasitemia thresholds vary based on the species of Plasmodium and the immune status of the patient [2]. The clinical manifestations of severe disease include impairment of liver function (i.e., acidosis, hypoglycemia, coagulopathy), thrombocytopenia, severe hemolysis with resultant anemia and jaundice, renal failure (i.e., acidosis, oliguria, acute tubular necrosis), direct and indirect lung damage (i.e., endothelial and alveolar damage, ARDS), cardiovascular impairment, and shock (Fig. 1). Secondary hemorrhage, volume overload, and pulmonary edema are also described [3].
Pregnant women are three times more likely to have severe malaria than their nonpregnant counterparts and the mortality rate among pregnant women with severe malaria may approach 50% [4, 5]. Although two vaccines against Malaria have been available since 2021 (RTS, S/AS01, and R21/Matrix-M), these are currently recommended only for children [6]. Across the 38 countries in the WHO African region with moderate to high malaria transmission, an estimated 12.7 million pregnancies (one in three) were exposed to malaria infection in 2022 [1].
Most cases are probably asymptomatic [7]. Local mosquito-borne transmission of malaria has also been recently identified in Florida, Texas, and Maryland which are non-endemic [8, 9]. In the UK, the overall number of imported malaria cases was 1369 in 2022 and 2,093 in 2023 [10]. In Italy, the number of malaria cases per 100,000 population was 571 in 2022 [11].
Cerebral malaria predominantly affects adults with immune suppression, children, and pregnant women [12, 13]. This potentially lethal complication, mostly of P. falciparum infection, stems from local inflammation, obstruction of the cerebral microcirculation, and impaired cerebral autoregulation, causing an increase in intracranial pressure and malignant brain edema [14]. Symptoms include impaired consciousness, seizures, and ultimately death [13] (Fig. 1).
We aimed to outline the considerations that may be relevant to anaesthesiologists treating a pregnant woman with malaria during labor and delivery.
Method
We searched PubMed, Google Scholar, and the Cochrane databases for any type of paper reporting original data regarding the mode of anesthesia and outcomes in hospitals for pregnant women with acute malaria undergoing labor and delivery. The search was conducted twice (up to 27th May 2024), each time by a single researcher (MF and IZ) to ensure thoroughness. The search terms and results are presented in Appendix 1. The reference lists of relevant articles were also manually scrutinized for additional potentially pertinent articles by all authors. No language restriction was applied during the search but only papers in English were screened. Potentially relevant papers were identified through title and abstract and downloaded in full for information extraction by two of the authors (MF and IZ). The information from these papers was then gathered conjunctly into a narrative summary of the literature by the two authors (MF and IZ). This content was reviewed and adjusted to best reflect the existing information by a third party (SE).
Discussion
The pathophysiology of malaria during pregnancy
The degree of adherence of infected erythrocytes to the placenta suggests the likelihood of severe malaria and poor pregnancy outcomes. P. falciparum and P. Knowlesi are more commonly associated with severe maternal–fetal outcomes [15, 16]. P. Vivax, P. Ovale, and P. Malaria infection infrequently results in severe outcomes [16, 17].
Successful pregnancy outcome requires the maintenance of a delicate balance between proimmune and anti-immune influences that allow placental development and fetal tolerance [18]. Many of the regulatory and cellular processes underlying these changes have yet to be elucidated. During malaria, massive mononuclear intervillous inflammatory infiltration has been associated with lower birth weights. Perivillous fibrin depositions have been associated with an increased risk of premature delivery [19]. Hence the time available for pre-delivery preparations may also be briefer than planned. The risk of transplacental malaria transmission is 1.5% in immune pregnant women and 7–10% in semi-immune and nonimmune women [20, 21]. All malaria species may cause congenital disease.
Malaria severity and labor considerations
Uncomplicated malaria is characterized by fewer than 2% parasitized erythrocytes without signs of severity or complicating features. Although any patient diagnosed with malaria during pregnancy should be admitted to the hospital due to the possibility of rapid deterioration, current guidelines suggest that labor should not be induced in uncomplicated malaria (Grade A) [22]. This suggestion is based on data from several prospective studies including 3000 pregnant women with uncomplicated malaria that were followed from diagnosis of malaria through treatment and birth. However, while the majority of those studies [23, 24] include data about outcomes such as premature labor and stillbirth, these papers actually present no data on labor induction.
Labor management should also follow protocol in case of fetal or maternal distress, including the timely use of interventions (e.g., forceps, vacuum, surgery) [22].
Severe malaria requires multidisciplinary care due to the combined risk of premature labor and maternal deterioration [25]. Even in severe malaria labour should only be induced for obstetric indications. If the patient is hemodynamically unstable, complete blood counts and coagulation profiles should assist in diagnosing occult hemorrhage. Dynamic evaluation of intravascular volume status should always precede fluid administration. A multicentre randomized controlled trial described increased 48-h mortality rates in low-resource settings among children receiving fluid resuscitation for treatment of septic shock, regardless of the type of fluid administered. After malaria was confirmed in 57% of the children, the increased mortality was attributed to the worsening of cerebral edema in response to fluid administration [26]. To date no equivalent study has been conducted in adults with malaria, therefore fluids should be administered judiciously.
A systematic review identified hypoalbuminemia in patients with malaria as an important indicator of severe disease, and in the general population, hypoalbuminemia is often due to liver and kidney failure as well as increased capillary permeability [27]. Additionally, in endemic regions, more than 40% of pregnant women may have hypoalbuminemia at their first antenatal visit [28]. A systematic review of malaria in the perioperative setting highlighted the risk of iatrogenic fluid overload resulting in pulmonary edema in the presence of hypoalbuminemia and low oncotic pressure [29]. Restrictive fluid administration has been associated with renal failure in hemodynamically compromised critically ill patients. While there is an increasing rate of peripartum renal failure, our search yielded no case reports ascribing renal failure to intravascular depletion in malaria.
Selecting the mode of anesthesia
Neuraxial anesthesia is usually preferred over general anesthesia as the risks of airway management during pregnancy may be exacerbated with malaria by soft tissue edema. Furthermore, despite concerns relating to parasite transfer into the Cerebrospinal fluid (CSF) through spinal anesthesia, no such case has been reported [29]. Plasmodium species cannot replicate in the CSF and are confined to cerebral capillaries [29]. Acute malaria may cause coagulopathy and thrombocytopenia during pregnancy [30]. It is therefore prudent to ensure that coagulation is unimpaired and platelet levels exceed the threshold for neuraxial anesthesia (50,000 to 80,000 10^6/L) (Table 1).
Barring evidence of coagulopathy, cerebral malaria, or hemodynamic compromise, performing neuraxial anesthesia is probably reasonable in most cases. However, more research is clearly needed regarding the safety of neuraxial anesthesia as our search identified only case reports (Table 2).
General anesthesia has also been described in pregnant patients with acute malaria (Table 2). Other than airway and hemodynamic management, maintenance of cerebral perfusion and intracranial pressure may require attention. During normal pregnancy, cerebral blood flow increases but intracranial pressure remains unaltered. Disruption of normal protective mechanisms may, however, increase the risk of cerebral edema. Furthermore, the first and second stages of labor may be accompanied by severe increases in intracranial pressure (39 mmHg and 71 mmHg, respectively) [41]. During normal pregnancy, blood–brain barrier permeability remains largely unchanged. Increased blood–brain barrier permeability is seen in animal models of preeclampsia, but whether this occurs in humans remains unknown. There is also weak evidence that Aquaporin 4 overexpression may influence brain edema formation and resolution in the second half of gestation [42]. Our search identified no descriptions of anesthesia management in pregnant women with CNS involvement in acute malaria.
Management of general anesthesia
Premedication with a benzodiazepine may be useful for both anxiolysis and seizure prevention. For malaria patients, the use of diazepam is most commonly described [43].
Patients with acute malaria may have low baseline PaCO2 levels [29]. Efforts employed to maintain intracranial pressure during induction and intubation should therefore include prevention of transient peri-intubation hypercapnia. In addition, blunting of the response to laryngoscopy and intubation with local anesthetics and effective neuromuscular blockade to prevent coughing may be employed. During surgery, a 15° head-up position and avoiding the use of endotracheal tube ties may improve cerebral venous drainage [29]. Whether mannitol effectively manages intracranial pressure in cerebral malaria remains debatable. Therefore, mannitol should only be used for salvage during impending cerebral herniation [29].
Several antimalarial drugs may interact with drugs used during and after the perioperative period. Quinine may enhance neuromuscular blockade and may aggravate hypoglycemia [44]. Chloroquine reduces the effect of neostigmine and pyridostigmine. Mefloquine interacts with anticholinergic drugs (e.g., physostigmine) to produce central anticholinergic syndrome [45]. Dapsone (which has largely been abandoned), can cause methemoglobinemia [46].
A systematic review of cardiovascular complications in patients with symptomatic, usually severe, malaria (43 studies, 3,117 adults and children), found a pooled prevalence estimate of 7% (95% CI 5–9) for any cardiovascular complication. Cardiovascular pathologies included myocarditis and acute coronary syndrome. All histopathological studies identified parasitized erythrocytes in the myocardium [47]. Quinine and artemisinin-based combination therapies, first-line treatments for malaria in many malaria-endemic areas, have been implicated in QT prolongation [48, 49]. One case report has attributed new onset Brugada Syndrome in a patient with malaria to propofol [50]. In cases with cardiac involvement, ketamine should probably not be used for induction of anesthesia as it may affect cardiac conduction, cause arrhythmias [51], and increase cerebral blood flow and intracranial pressure [29].
All volatile anesthetics induce a dose-dependent increase in cerebral blood flow and reduce cerebral oxygen consumption. If immediate post-surgery tracheal extubation and neurological assessment are needed, the rapid offset and recovery from sevoflurane and desflurane may make these drugs more suitable than isoflurane for maintenance of anesthesia [29]. Since postoperative extubation is usually planned, sedative agents and opioids with a prolonged effect should be administered in measured doses if at all.
Management after delivery
Post-delivery, the parturient should be managed in a highly monitored environment where disease exacerbation or complications may be rapidly identified and treated. Periodic neurological evaluation is recommended, particularly in cases with suspected central nervous system involvement. A retrospective analysis comparing women in malaria-endemic areas (n = 4023) to women in non-endemic areas (n = 6655) showed no increased risk of postpartum hemorrhage in women with malaria. However, among those with hemorrhage, a higher mean peripartum blood loss was observed [52]. A longitudinal study that followed women from antenatal care to the immediate postpartum period (n = 675) noted higher blood loss in the two hours after delivery among bleeding women with malaria compared to those without malaria. However, the method used to assess blood loss was inexact [16].
Conclusions
Given the prevalence of malaria, our search (Appendix 1) yielded a surprising paucity of literature. Information on the management of anesthesia in pregnant patients with acute disease remains scarce. Much of our understanding is based on case studies, predominantly from regions where health infrastructure and resource limitations may affect management.
Availability of data and materials
No datasets were generated or analysed during the current study.
Change history
01 August 2024
A Correction to this paper has been published: https://doi.org/10.1186/s44158-024-00189-9
Abbreviations
- ICP:
-
Increased intracranial pressure
- CSF:
-
Cerebrospinal fluid
- ICU:
-
Intensive care unit
- P:
-
Plasmodium
- CNS:
-
Central nervous system
- ARDS:
-
Acute respiratory distress syndrome
References
World Health Organisation (2023) World Malaria Report 2023. www.who.int. Available from: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023. Cited 2024 May 29
Poespoprodjo JR, Douglas NM, Ansong D, Kho S, Anstey NM (2023) Malaria. Lancet 402(10419):2328–2345
Publication of this supplement was sponsored jointly by the World Health Organization, the Medicines for Malaria Venture, Roll Back Malaria and The Wellcome Trust (2014) Severe Malaria. Trop Med Int Health 19(s1):7–131. https://onlinelibrary.wiley.com/doi/full/10.1111/tmi.12313_2
World Health Organization (2015) Guidelines for the Treatment of Malaria. Third Edition 3rd ed. WHO | Regional Office for Africa. Available from: https://www.afro.who.int/publications/guidelines-treatment-malaria-third-edition. Cited 2024 May 29
Sebastian F (2008). In: Monif GRG, Baker DA (ed) Infectious diseases in obstetrics and gynecology. RC Press, London
World Health Organization (2022) Q&A on RTS,S Malaria Vaccine. www.who.int. Available from: https://www.who.int/news-room/questions-and-answers/item/q-a-on-rts-s-malaria-vaccine. Cited 2024 May 29
Kassie GA, Azeze GA, Gebrekidan AY, Lombebo AA, Adella GA, Haile KE et al (2024) Asymptomatic malaria infection and its associated factors among pregnant women in ethiopia; a systematic review and meta-analysis. Parasite Epidemiol Control 24(339):e00339-e349
Blackburn D (2023) Outbreak of locally acquired mosquito-transmitted (Autochthonous) Malaria - Florida and Texas, May-July 2023. Vol. 72, MMWR. Morbidity and Mortality Weekly Report. Available from: https://www.cdc.gov/mmwr/volumes/72/wr/mm7236a1.htm?s_cid=mm7236a1_w. Cited 2024 May 29
Duwell M (2023) Notes from the field: locally acquired mosquito-transmitted (Autochthonous) Plasmodium Falciparum Malaria - National Capital Region, Maryland, August 2023. Vol. 72, MMWR. Morbidity and Mortality Weekly Report. Available from: https://www.cdc.gov/mmwr/volumes/72/wr/mm7241a3.htm. Cited 2024 May 29
Provisional Imported Malaria Case Numbers in the UK by species: 2022 and 2023 Monthly Figures. UK Health and Social Care. 2024. Available from: https://www.gov.uk/government/publications/imported-malaria-in-the-uk-statistics. Cited 2024 May 29
(2024) Malaria - Annual Epidemiological Report for 2022. www.ecdc.europa.eu. Available from: https://www.ecdc.europa.eu/en/publications-data/malaria-annual-epidemiological-report-2022. Cited 2024 May 29
Murthy JMK, Dastur FD, Khadilkar SV, Kochar DK (2014) Rabies, Tetanus, Leprosy, and Malaria. Handbook of Clinical Neurology. Elsevier, The writers are based in India, pp 1501–1520
Idro R, Marsh K, John CC, Newton CRJ (2010) Cerebral Malaria: Mechanisms of Brain Injury and Strategies for Improved Neurocognitive Outcome. Pediatr Res 68(4):267–274
Smith RL, Ikeda AK, Rowley CA, Khandhadia A, Gorbach AM, Chimalizeni Y et al (2023) Increased brain microvascular hemoglobin concentrations in children with cerebral malaria. Sci Transl Med 15(713):eadh4293
Uneke CJ (2007) Impact of placental plasmodium falciparum malaria on pregnancy and perinatal outcome in Sub-Saharan Africa. Yale J Biol Med 80(2):39–50
Uddenfeldt Wort U, Hastings I, Bergström S, Massawe S, Lipingu C, Brabin BJ (2007) Increased postpartum blood loss in pregnancies associated with placental malaria. Int J Gynaecol Obstet 96(3):171–175
Nosten F, McGready R, Simpson J, Thwai K, Balkan S, Cho T et al (1999) Effects of plasmodium vivax malaria in pregnancy. The Lancet 354(9178):546–549
Mor G, Cardenas I (2010) The immune system in pregnancy: a unique complexity. Am J Reprod Immunol 63(6):425–433
Menendez C, Ordi J, Ismail MR, Ventura PJ, Aponte JJ, Kahigwa E et al (2000) The impact of placental malaria on gestational age and birth weight. J Infect Dis 181(5):1740–1745
McGregor IA (1984) Epidemiology, malaria and pregnancy. Am J Trop Med Hyg 33(4):517–525
Bergström S, Fernandes A, Schwalbach J, Perez O, Miyar R (1993) Materno-fetal transmission of pregnancy malaria: an immunoparasitological study on 202 parturients in maputo. Gynecol Obstet Invest 35(2):103–107
McGready R, Ashley E, Nosten F, Rijken M, Dundorp A (2010) The Diagnosis and Treatment of Malaria in Pregnancy (Green-top Guideline No. 54b). Royal College of Obstetricians and Gynaecologists. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/the-diagnosis-and-treatment-of-malaria-in-pregnancy-green-top-guideline-no-54b/. Cited 2024 May 29
McGready R, Ashley Elizabeth A, Moo E, Cho T, Barends M, Hutagalung R et al (2005) A randomized comparison of artesunate-atovaquone-proguanil versus quinine in treatment for uncomplicated falciparum malaria during pregnancy. J Infect Dis 192(5):846–853
McGready R, Cho Samuel T, Villegas L, Brockman A, van Vugt M, Looareesuwan S et al (2001) Randomized comparison of quinine-clindamycin versus artesunate in the treatment of falciparum malaria in pregnancy. Trans R Soc Trop Med Hyg 95(6):651–656
Global Malaria Programme (GMP) (2013) Management of Severe malaria: a Practical Handbook. www.who.int. Available from: https://www.who.int/publications/i/item/9789241548526. Cited 2024 May 29
Maitland K, Kiguli S, Opoka RO, Engoru C, Olupot-Olupot P, Akech SO et al (2011) Mortality after fluid bolus in African children with severe infection. N Engl J Med 364(26):2483–2495
Kuraeiad S, Kotepui KU, Mahittikorn A, Masangkay FR, Wilairatana P, Suwannatrai AT et al (2024) Albumin levels in malaria patients: a systematic review and meta-analysis of their association with disease severity. Sci Rep 3(14):10185
Bahizire E, Tugirimana PL, Dramaix M, Zozo D, Bahati M, Mwale A, et al. (2017) Malaria Is More Prevalent than Iron Deficiency among Anemic Pregnant Women at the First Antenatal Visit in Rural South Kivu. The American Journal of Tropical Medicine and Hygiene 97(5):1551–60. Available from: https://pubmed.ncbi.nlm.nih.gov/29016317/. Cited 2023 Apr 16
Soltanifar D, Carvalho B, Sultan P (2014) Perioperative considerations of the patient with malaria. Can J Anesth 62(3):304–318
Tan SO, McGready R, Zwang J, Pimanpanarak M, Sriprawat K, Thwai KL et al (2008) Thrombocytopaenia in Pregnant Women with Malaria on the Thai-Burmese Border. Malar J 7(1):209
Bauer ME, Arendt K, Beilin Y, Gernsheimer T, Perez Botero J, James AH et al (2021) The society for obstetric anesthesia and perinatology interdisciplinary consensus statement on neuraxial procedures in obstetric patients with thrombocytopenia. Anesth Analg 132(6):1531–1544
Harrop-Griffiths W, Cook T, Gill H, Hill D, Ingram M, Makris M et al (2013) Regional anaesthesia and patients with abnormalities of coagulation. Anaesthesia 68(9):966–972
Ali S, Jones GL, Culligan DJ, Marsden PJ, Russell N, Embleton ND et al (2015) Guidelines for the Diagnosis and Management of Acute Myeloid Leukaemia in Pregnancy. Br J Haematol 170(4):487–495
Martins Fonseca N, Rodrigues Alves R, Pontes JPJ (2014) Recomendações Da SBA Para Segurança Na Anestesia Regional Em Uso De Anticoagulantes. Braz J Anesth 64(1):1–15. https://doi.org/10.1016/j.bjan.2013.04.008. Cited 2024 May 29
Samama CM, Djoudi R, Lecompte T, Nathan-Denizot N, Schved JF (2005) Perioperative Platelet transfusion: Recommendations of the Agence Française De Sécurité Sanitaire Des Produits De Santé (AFSSaPS) 2003. Can J Anesth 52(1):30–37
Zanfini BA, Dell’Anna AM, Catarci S, Frassanito L, Vagnoni S, Draisci G (2016) Anesthetic management of urgent cesarean delivery in a parturient with acute malaria infection: a case report. Korean J Anesthesiol 69(2):193
Sultan P, Green C, Riley E, Carvalho B (2012) Spinal anaesthesia for caesarean delivery in a parturient with babesiosis and lyme disease. Anaesthesia 67(2):180–183
Mathew DC, Loveridge R, Solomon AW (2011) Anaesthetic management of caesarean delivery in a parturient with malaria. Int J Obstet Anesth 20(4):341–344
Samanta S, Samanta S, Haldar R (2014) Emergency caesarean delivery in a patient with cerebral malaria-leptospira co infection: anaesthetic and critical care considerations. Indian J Anaesth 58(1):55
Sojka D, Jalovecká M, Perner J (2022) Babesia, Theileria, Plasmodium and Hemoglobin. Microorganisms 10(8):1651
Alves S, Sousa N, Cardoso LÍ, Alves J (2022) Multidisciplinary Management of Idiopathic Intracranial Hypertension in pregnancy: Case Series and Narrative Review. Braz J Anesthesiol (English Edition) 72(6):790–4
Godoy DA, Robba C, Paiva WS, Rabinstein AA (2021) Acute intracranial hypertension during pregnancy: special considerations and management adjustments. Neurocrit Care 36(1):302–316
SaaChai T, Lin J (2012) Anesthetic aspect of malaria disease: a brief review. Middle East J Anaesthesiol 21(4):457–462
Sieb JP, Milone M, Engel AG (1996) Effects of the quinoline derivatives quinine, quinidine, and chloroquine on neuromuscular transmission. Brain Res 712(2):179–189
Speich R, Haller A (1994) Central anticholinergic syndrome with the antimalarial drug mefloquine. N Engl J Med 331(1):57–58
Szeremeta W, Dohar JE (1995) Dapsone - Induced methemoglobinemia: an Anesthetic Risk. Int J Pediatr Otorhinolaryngol 33(1):75–80
Holm AE, Gomes LC, Marinho CRF, Silvestre OM, Vestergaard LS, Biering-Sørensen T et al (2021) Prevalence of cardiovascular complications in malaria: a systematic review and meta-analysis. Am J Trop Med Hyg 104(5):1643
Wroblewski HA, Kovacs RJ, Kingery JR, Overholser BR, Tisdale JE (2012) High Risk of QT Interval Prolongation and Torsades De Pointes Associated with Intravenous Quinidine Used for Treatment of Resistant Malaria or Babesiosis. Antimicrob Agents Chemother 56(8):4495–4499
Wu W, Lu C, Liang Y, Zhang H, Deng C, Wang Q et al (2021) Electrocardiographic effect of artemisinin-piperaquine, dihydroartemisinin-piperaquine, and artemether-lumefantrine treatment in falciparum malaria patients. Rev Soc Bras Med Trop 54:e05362020
Meggiolaro M, Zorzi A, El Maghawry M, Peruzza F, Migliore F, Pittoni GM (2013) Brugada ECG disclosed by acute malaria: is it all about fever and propofol? J Clin Anesth 25(6):483–487
Aya Antoine GM, Robert E, Bruelle P, Lefrant JY, Juan JM, Peray P et al (1997) Effects of Ketamine on Ventricular Conduction, Refractoriness, and Wavelength. Anesthesiology 87(6):1417–1427
Piper C, Brabin BJ, Alpers MP (2001) Higher risk of post-partum hemorrhage in malarious than in non-malarious areas of papua new guinea. Int J Gynecol Obstet 72(1):77–78
Acknowledgements
Not applicable
Disclosure
The figure was drawn by DALL-E3 based on prompts given by one of the authors (IZ).
Funding
Not applicable.
Author information
Authors and Affiliations
Contributions
Study conception and design: SE, IZ, MF; data collection: MF, MM, MV; draft manuscript preparation: SE, IZ, MF, MM, EG, MN. All authors reviewed the results and approved the final version of the manuscript. DALL-E3 drew the figure based on prompts given by IZ.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
SE—Serves as editor for Cochrane and several anesthesia and intensive care journals and is Chief Medical Officer of Medint.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article has been updated to correct an author name.
Appendix
Appendix
Search terms (date of last search 27th May 2024)
“malaria” and “epidural” and “pregnancy”—0 results.
“malaria” and “spinal” and “pregnancy”—6 results, 2 relevant case reports.
Soltanifar D, Jacobs M, Jones T, McGlennan A, Sultan P. Spinal anaesthesia for emergency caesarean delivery in a parturient with falciparum malaria. Int J Obstet Anesth. 2015 Feb;24(1):91. https://doi.org/10.1016/j.ijoa.2014.07.003. Epub 2014 Jul 16. PMID: 25433574.
Zanfini BA, Dell'Anna AM, Catarci S, Frassanito L, Vagnoni S, Draisci G. Anesthetic management of urgent cesarean delivery in a parturient with acute malaria infection: a case report. Korean J Anesthesiol. 2016 Apr;69(2):193–6. https://doi.org/10.4097/kjae.2016.69.2.193. Epub 2016 Mar 30. PMID: 27066212; PMCID: PMC4823419.
“malaria” and “neuraxial” and “pregnancy”—0 results.
“malaria” and “neuraxial anesthesia”—1 relevant result (cited in the article).
(Soltanifar D, Carvalho B, Sultan P. Perioperative considerations of the patient with malaria. Can J Anaesth. 2015 Mar;62(3):304–18. https://doi.org/10.1007/s12630-014-0286-7. Epub 2014 Dec 4. PMID: 25471683; PMCID: PMC7102007.)
“intravascular depletion” and “malaria”—1 relevant result (cited in the article).
Pugliese CM, Adegbite BR, Edoa JR, Mombo-Ngoma G, Obone-Atome FA, Heuvelings CC, Bélard S, Kalkman LC, Leopold SJ, Hänscheid T, Adegnika AA, Huson MA, Grobusch MP. Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients. Infection. 2022 Feb;50(1):65–82. https://doi.org/10.1007/s15010-021-01637-2. Epub 2021 Jun 10. PMID: 34110570; PMCID: PMC8803774.
"Babesiosis" + "spinal" + "pregnancy"- 1 relevant result (cited in the article).
Sultan P, Green C, Riley E, Carvalho B. Spinal anaesthesia for caesarean delivery in a parturient with babesiosis and Lyme disease. Anaesthesia. 2012 Feb;67(2):180–3. https://doi.org/10.1111/j.1365-2044.2011.06941.x. PMID: 22251109.
Added search based on reviewers comments (16 July 2024)
“hypoalbuminemia” and “pregnancy” and “malaria”—no relevant results.
respiratory depression and diazepam and delivery—11 papers, 1 relevant (Chinese).
diazepam and placenta and respiratory depression—2 papers, none relevant.
benzodiazepine and placenta and respiratory depression—2 papers, none relevant.
"APGAR" and "diazepam" and "delivery" and "anxiolysis"—no relevant results.
"APGAR" and "diazepam" and "anxiolysis"—no relevant results.
"APGAR" and "diazepam" and "anesthesia"—24 papers, 1 relevant.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Zahavi, I., Fons, M., Meir, M. et al. Anesthetic approach to pregnant patients with malaria: a narrative review of the literature. J Anesth Analg Crit Care 4, 48 (2024). https://doi.org/10.1186/s44158-024-00185-z
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s44158-024-00185-z