Continuous spinal anaesthesia for caesarean section in a patient with peripartum cardiomyopathy

Bansal, Teena; Jaiswal, Rajmala; Bala, Manju; Seelwal, Deepika

doi:10.4103/ija.ija_769_18

Cited by 7 publications

(4 citation statements)

References 6 publications

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“…The stability may be due to preloading, graded intrathecal induction, and maintenance drugs being administered as a continuous infusion by a syringe pump throughout the surgery. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial

Sangadala,

Talawar,

Tripathy

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: Thoracic continuous spinal anaesthesia (TCSA) is emerging as the sole anaesthetic for major abdominal surgery due to its better perioperative outcomes. This study was designed to evaluate block characteristics and outcomes in ‘opioid-free’ and ‘opioid-based’ TCSA. Methods: After ethical approval, trial registration and written informed consent, 50 adult patients undergoing major abdominal surgery were randomised into ‘opioid-free’ (bupivacaine alone) and ‘opioid-based’ (bupivacaine with fentanyl) groups. After confirmation of T4-L1 dermatome level of spinal anaesthesia, sedation by intravenous (IV) midazolam (0.02–0.05 mg/kg), ketamine (0.25 mg/kg) and dexmedetomidine (bolus dose of 1 µg/kg IV over 10 min followed by 0.2–0.7 µg/kg/h infusion) were started. The primary outcome measured was postoperative pain scores for 72 h in both groups. The secondary objectives were rescue opioid requirement, and the dose of bupivacaine required to achieve T4 level. Data were compared using the two-sided Student t-test, Mann-Whitney and Fisher’s exact tests. Results: The ‘opioid-based’ group performed significantly better compared with the ‘opioid-free’ group concerning pain scores at rest at 0 h (P = 0.023), 18 h (P = 0.023) and 24 h (P = 0.016) postoperatively, decreased intrathecal bupivacaine requirement [(induction (P = 0.012) and maintenance (P = 0.031)], postoperative rescue fentanyl requirement (P = 0.018) and patient satisfaction (P = 0.032) at the cost of increased postoperative nausea and vomiting (P = 0.049). Conclusion: The ‘opioid-based’ TCSA provided better postoperative analgesia with significantly lesser postoperative pain scores when compared to the ‘opioid-free’ group in patients undergoing major abdominal surgery.

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“…The stability may be due to preloading, graded intrathecal induction, and maintenance drugs being administered as a continuous infusion by a syringe pump throughout the surgery. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial

Sangadala,

Talawar,

Tripathy

et al. 2024

Indian Journal of Anaesthesia

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“…Kotekar et al 10 reported a case of PPCM in 37yr old patient with 37 weeks of gestation. The patient did not have favourable outcome, succumbing to death on the 8 th post-operative day, however the baby survived.…”

Section: Discussionmentioning

confidence: 99%

Decisive and timely management - A case of fatal acute decompensated cardiomyopathy at 35 weeks of pregnancy

Deshpande

Santosh

2019

Sri Lankan J Anaesthesiol

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Peripartum cardiomyopathy (PPCM) is a relatively rare disease occurring most commonly in the postpartum period. A small subset of patients with PPCM present at later stages of pregnancies. The management of PPCM involves guideline-based treatment of cardiac failure. There is a paucity of data regarding timing of delivery and final outcome. Patients presenting with decompensated failure or progressively worsening symptoms need emergent termination of pregnancy along with stabilisation. We present a 35-week pregnant patient in cardiac failure in whom early delivery and effective postoperative management resulted in a favourable outcome for both mother and child.

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“…1 Peripartum Cardiomyopathy manifests as cardiac failure in the absence of demonstrable aetiology in the last month of pregnancy or within 5 months postpartum with ejection fraction reduced to less than or equal to 45%. 2 Although its clinical symptomatology is mostly dyspnoea on exertion, some patients present with complex arrhythmias or embolic episodes. Tachyarrhythmias may also occur in cardiomyopathies including supraventricular tachycardia, atrial fibrillation and rarely ventricular tachycardia.…”

Section: Introductionmentioning

confidence: 99%

Anaesthetic management of a covid 19 positive parturient with newly diagnosed cardiomyopathy presenting with supraventricular tachycardia

Venkat

Basker²,

Karthikeyan³

2021

IJCA

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Covid 19 has been a globally concerning pandemic affecting more than 20 million population worldwide including pregnant women. Cardiomyopathy is a rare affliction occurring in the last trimester of pregnancy or early postpartum manifesting as acute heart failure/ development of sudden arrhythmias/ thromboembolic complications. Anaesthetic management of such patients for caesarean section can be quite challenging, the main goals being maintenance of preload and afterload while avoiding myocardial depression at the same time whatever be the choice of anaesthetic technique. Here we report the successful management of a Covid-19 positive parturient under regional anaesthesia who was recently diagnosed with cardiomyopathy presenting with supraventricular tachycardia.

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Continuous spinal anaesthesia for caesarean section in a patient with peripartum cardiomyopathy

Cited by 7 publications

References 6 publications

Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial

Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial

Decisive and timely management - A case of fatal acute decompensated cardiomyopathy at 35 weeks of pregnancy

Anaesthetic management of a covid 19 positive parturient with newly diagnosed cardiomyopathy presenting with supraventricular tachycardia

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