A 38-year-old primiparous patient with placenta previa and active vaginal bleeding arrives for planned cesarean. Which induction plan is most appropriate?

A 38-year-old primiparous patient with placenta previa and active vaginal bleeding arrives for planned cesarean. Which induction plan is most appropriate?

• A. Spinal Anesthetic With 12 To 15 Mg Bupivacaine
• B. Epidural Anesthetic With 20 To 25 Ml 3% 2-Chloroprocaine
• C. General Anesthetic Induction With 3 To 4 Mg/Kg Thiopental, Intubation With 1 To 1.5 Mg/Kg Succinylcholine
• D. General Anesthesia Induction With 0.5 To 1 Mg/Kg Ketamine, Intubation With 1 To 1.5 Mg/Kg Succinylcholine

Answer: (D)

The main issue being tested is how to protect both mother and fetus when there is placenta previa with active vaginal bleeding. In this situation you want to secure the airway quickly and maintain stable maternal blood pressure to sustain uteroplacental perfusion. Neuraxial anesthesia (spinal or epidural) carries a risk of abrupt hypotension from sympathetic blockade, which can worsen uteroplacental perfusion in a bleeding patient and may be unsafe if there's concern for coagulopathy. So the safest plan is general anesthesia with rapid airway control. Choosing ketamine for induction provides cardiovascular stability; it preserves blood pressure and systemic vascular resistance better than thiopental or other induction agents, which helps maintain uteroplacental blood flow during the critical period of airway securement. Using succinylcholine for rapid-sequence intubation ensures swift airway protection and minimizes aspiration risk in obstetric patients. In contrast, thiopental tends to cause more hypotension, risking reduced placental perfusion and greater fetal risk. Therefore, induction with ketamine and rapid intubation with succinylcholine is the most appropriate plan in this scenario.

The main issue being tested is how to protect both mother and fetus when there is placenta previa with active vaginal bleeding. In this situation you want to secure the airway quickly and maintain stable maternal blood pressure to sustain uteroplacental perfusion. Neuraxial anesthesia (spinal or epidural) carries a risk of abrupt hypotension from sympathetic blockade, which can worsen uteroplacental perfusion in a bleeding patient and may be unsafe if there's concern for coagulopathy. So the safest plan is general anesthesia with rapid airway control.

Choosing ketamine for induction provides cardiovascular stability; it preserves blood pressure and systemic vascular resistance better than thiopental or other induction agents, which helps maintain uteroplacental blood flow during the critical period of airway securement. Using succinylcholine for rapid-sequence intubation ensures swift airway protection and minimizes aspiration risk in obstetric patients. In contrast, thiopental tends to cause more hypotension, risking reduced placental perfusion and greater fetal risk. Therefore, induction with ketamine and rapid intubation with succinylcholine is the most appropriate plan in this scenario.