Anaesthetic management in a parturient with Ebstein′s anamoly

Sushma, K S; Shaikh, Safiya I; Ashwini, H

doi:10.4103/2249-4472.123307

Cited by 4 publications

(5 citation statements)

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“…The severity of hemodynamic derangements in patients with Ebstein's anomaly depends on the degree of displacement and functional status of tricuspid valve. [3][4][5][6] Most patients who have an interatrial communication (atrial septal defect, PFO) can develop CHF, worsening cyanosis, paradoxical embolization, brain abscess, and sudden death. Basic goals in these patients are to maintain sinus rhythm, preload, after load, and to prevent the increase in the magnitude of right to left intracardiac shut.…”

Section: Discussionmentioning

confidence: 99%

“…Basic goals in these patients are to maintain sinus rhythm, preload, after load, and to prevent the increase in the magnitude of right to left intracardiac shut. [6][7][8] Case studies have reported on successful use of epidural anesthesia with intact interatrial septum and good ventricular function. 3,4,[8][9][10][11] Although general anesthesia is considered safe, we administered epidural anesthesia for this patient as a result of assessing the patient's sensorium in the event of hyponatremia, if TURP syndrome develops.…”

Section: Discussionmentioning

confidence: 99%

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Epidural Anesthesia for a Patient with Ebstein\'s Anomaly posted for Transurethral Resection of Prostate

Karthik¹,

J²,

Shree³

et al. 2018

The Journal of Medical Sciences

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidural Anesthesia for a Patient with Ebstein\'s Anomaly posted for Transurethral Resection of Prostate

Karthik¹,

J²,

Shree³

et al. 2018

The Journal of Medical Sciences

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“…(16) Administration of intravenous fluids requires a cautious approach so as not to overload the circulation and hence prevent the development of congestive cardiac failure. (17) Introduction of central venous catheters is also associated with technical difficulty and precipitation of arrhythmias. (12) Reports of subarachnoid block being used in patients with Ebsteins anomaly are scarce.…”

Section: Discussionmentioning

confidence: 99%

Subarachnoid Block in a Patient With Ebstein’s Anomaly

Devi¹,

R²,

Vasundhara³

et al. 2015

jemds

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BACKGROUND AND OBJECTIVES:Ebstein's anomaly is one of the rare congenital heart conditions that occur due an abnormal development of the tricuspid valve with "atrialization" of the right ventricle, leading to a small effective distal portion causing poor ventricular function. It may be associated with other cardiac malformations, rhythm disturbances or even a failing heart. When these patients report for surgery, the anaesthetic considerations are serious and reports about the use of central neuraxial blockade for the same is rare. Hence this study aims to provide some knowledge and information on the use of subarachnoid block in a case of Ebstein's anomaly posted for haemorrhoidectomy. PRESENTATION: DIAGNOSIS AND MANAGEMENT: A 48year old female patient with external and internal haemorrhoids was posted for haemorrhoidectomy. She was a known hypertensive with grade 1 hypertensive retinopathy on fundoscopy and was on treatment for the same. ECG showed a WPW syndrome pattern and chest radiograph showed mild cardiomegaly. 2D echocardiography revealed a dilated right atrium and right ventricle, with apical displacement of septal tricuspid leaflet and Ebstein's anomaly. There was moderate tricuspid regurgitation. Biventricular function was good with intact septum. The ejection fraction was 65%. The patient was given a low subarachnoid block in anti-trendelenberg position in the L3-L4 interspace with a combination of bupivacaine 0.5% heavy 4.5mg and fentanyl 15mcg (Total volume of 1.2ml). There was good anaesthetization with sensory and motor blockade of the saddle area. The patient was haemodynamically stable, without hypotension, rhythm disturbances or any other untoward incident throughout the procedure and in the postoperative period. CONCLUSION: Very few reports are available on the use of subarachnoid block in patients with Ebstein's anomaly. The feared drawback with its use is the occurrence of precipitous hypotension, leading to worsening of right to left shunt when it is present. Though our patient had an associated Wolff Parkinson White syndrome, she had no additional serious conditions like septal defects with reversal of flow or cardiac failure. Hence, we considered giving a low dose saddle block in view of the site of surgery and to minimize the sympathetic blockade.

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“…The goal of anaesthesia in these patients is to maintain sinus rhythm and both preload and afterload. [ 5 ] Subarachnoid blocks and general anaesthesia (GA) can potentially worsen the right to left cardiac shunt due to sudden decrease in systemic vascular resistance. Additionally, GA is associated with increased catecholamine levels and intrathoracic pressure which further increase intracardiac shunt.…”

mentioning

confidence: 99%

“…Insertion of central line increases likelihood of arrhythmias, paradoxical emboli and bacterial endocarditis. [ 5 ] Pregnant women with Ebstein's anomaly cannot withstand either haemorrhage or excessive fluid resuscitation.…”

mentioning

confidence: 99%