Caesarean section under continuous spinal anaesthesia in a parturient with pulmonary hypertension: A case report

Abstract

Introduction Women with pulmonary hypertension have high morbidity and mortality during pregnancy. The inability to increase cardiac output can lead to heart failure, while hypercoagulability and reduced systemic vascular resistance also lead to other risks. Case management This paper report the case of a parturient admitted for caesarean section under continuous spinal anaesthesia scheduled at 34 weeks of amenorrhea following severe pulmonary arterial hypertension. She had a history of significant mitral insufficiency. The procedure was performed without incident. The catheter was removed immediately postoperatively. The baby was female and in good health. She was transferred to the resuscitation service with restoration of oral nutrition. Conclusion Loco-regional anaesthesia is to be preferred in pulmonary hypertension associated to pregnancy. In order to reduce the risk of mortality due to general anaesthesia for this type of patient, it is possible to practice the continuous spinal anaesthesia for caesarean section without having hemodynamic consequences.

Cesarean Section in a Group 1 Pulmonary Hypertension Parturient Patient: A Case Report

“…Conversely, epidural anesthesia can help avoid the aforementioned complications. Numerous studies have demonstrated that neuraxial anesthesia techniques used during C-sections lead to successful outcomes, primarily due to their reduced impact on hemodynamics [ 8 , 9 , 15 , 16 , 17 ]. With the successful and timely placement of the epidural catheter and gradual loading of local anesthetics and opioids throughout the intraoperative and postpartum periods, our patient could achieve adequate analgesia and hemodynamic stability.…”

“…This can result in right-sided heart failure and limited preload delivery to the left side of the heart, which precipitates hypotension and even death. Recent literature shows that although PH in pregnancy is uncommon (1/100,000), maternal and fetal mortality rates can range from 11-50% because of this sudden hemodynamic compromise [ 2 , 7 , 8 ]. Coupled with the cardiovascular effects of anesthesia, these patients can be difficult to manage.…”

Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association

“…142 Continuous spinal anesthesia with slow titration of local anesthetic has been described as an alternative option in the obstetric population, but it is not widely used. 143 For neuroaxial technique, an epidural is more easily titrated to prevent an acute reduction in SVR. Vasopressor infusion should be readily available to counteract the sympatholytic effect of neuroaxial anesthesia, and care should be taken to avoid excessive fluid administration.…”

“…145 No prospective studies have compared epidural, spinal, or combined spinal-epidural with general anesthesia, and all approaches have been described in case reports and series. 117,141,143,[146][147][148][149][150][151][152][153][154][155] Obstetric care for patients with PH should be performed at specialized PH centers with experienced anesthesia and obstetric teams. A multidisciplinary team involving an experienced obstetrician, PH specialist, and anesthesiologist is imperative in the management of obstetric patients with PH.…”