We present two cases in which parturients with the diagnosis of peripartum cardiomyopathy presented in congestive heart failure for emergent Cesarean section. Continuous spinal anesthesia and combined spinal-epidural anesthesia were successfully employed as the anesthetic techniques for the procedures. Both patients remained hemodynamically stable during surgery and were discharged home on postoperative days 5 and 4 respectively.

We sought to determine the contemporary frequency of seizures, and the associated cardiovascular changes, resulting from local anesthetic-induced seizures in all patients undergoing brachial plexus, epidural, and caudal regional anesthetics. We investigated the following variables: development and treatment of seizure or cardiac arrest during the regional anesthetic, type of anesthetic (including local anesthetic used), gender, age, ASA physical status class and type of operation (elective or emergent). In addition, each patient who experienced a seizure underwent retrospective review of the acute event to determine the arterial blood pressure and heart rate changes accompanying the seizure, as well as details of the regional block technique. There was a significant difference between the rate of seizure development between epidural, brachia, and caudal anesthetics, with caudal > brachial > epidural. A significant difference was also noted in the rate of seizure development within types of brachial block, with supraclavicular and interscalene > axillary. No adverse cardiovascular, pulmonary or nervous system events were associated with any of the seizures, including the 16 patients who received bupivacaine blocks. The frequency of local anesthetic-induced seizures stratified by block type has a wide range, and cardiovascular collapse after bupivacaine-associated seizure has a low incidence.

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Careful evaluation and documentation of the patient's baseline neurological status, a thorough discussion with the patient regarding the risks and benefits of the technique for labor analgesia, and an appreciation of the limited experience with this kind of clinical situation are important.