Combined spinal-epidural anesthesia for urgent cesarean section in a parturient with a single ventricle: a case report

Abstract

The number of women with major congenital heart defects reaching reproductive age is likely increasing. We herein describe the anesthetic management of a 33-year-old woman at 37 gestational weeks with a history of Glenn surgery who was undergoing an urgent cesarean section due to pathological cardiotocography. Combined spinal-epidural anesthesia was the most suitable technique for urgent cesarean section in our patient with a single ventricle and phasic flow in the pulmonary artery because it provided rapid-onset anesthesia with negligible hemodynamic effects.

Cesarean Section With Spinal Anesthesia in a Patient With Double Outlet Right Ventricle

“…In addition, the negative inotropic effects of general anesthetics can lead to hypotension. 5 In the present case, oxytocin was administered IM for prevention of postpartum hemorrhage (World Health Organization guidelines state that oxytocin can be administered IV or IM for prevention of postpartum hemorrhage). Vasodilation and hypotension can occur with IV oxytocin, and pulmonary edema has occurred with only 5 IU of IV oxytocin in a patient with uncorrected DORV who underwent LSCS under epidural anesthesia.…”

“…A cesarean section has been reported in a patient under combined spinal-epidural anesthesia with a palliated (Blalock-Hanlon procedure and banding of the PA) 4 single ventricle with BDG shunt, 5 and in a patient under epidural anesthesia with uncorrected DORV. 6 Herein, a case of LSCS for a DORV patient with a BDG shunt under spinal anesthesia is reported.…”

Anesthetic considerations for Fontan circulation and pregnancy

“…One technique is to administer 5 mL of 2% lidocaine every 5 minutes until a surgical level of anesthetic is achieved. 64,65 Single-shot spinal anesthetics require less time to place, but result in a rapid sympathectomy, which can be detrimental to patients with Fontan physiology and are not recommended for this patient population. 38 Continuous spinal catheters have been incrementally dosed in women with complex cardiac diseases, but resulted in 8.8% of women having an undesirable postdural puncture headache requiring a blood patch.…”

“…The benefit of epidural anesthesia over a single-shot spinal anesthesia is the ability to slowly and incrementally administer local anesthetic to a dermatomal level necessary for surgical anesthesia while being able to respond to hemodynamic changes throughout the process. One technique is to administer 5 mL of 2% lidocaine every 5 minutes until a surgical level of anesthetic is achieved 64,65. Single-shot spinal anesthetics require less time to place, but result in a rapid sympathectomy, which can be detrimental to patients with Fontan physiology and are not recommended for this patient population 38.…”