Low Dose Combined Spinal-Epidural Anesthesia: An Anesthesia Technique for Cesarean Section in a Patient Suffering from Congenitally Corrected Transposition of Great Arteries and Severe Pulmonary Stenosis

Abstract

A primigravida, aged 22 years, at 39th gestational week was hospitalized with dyspnea since onset of labor. On systemic evaluation and echocardiography, she was diagnosed to have congenitally corrected transposition of the great arteries (CCTGA) along with severe pulmonic stenosis and bidirectional ventricular and atrial septal defects. A multidisciplinary team provided initial symptomatic management, stratified the risk and planned for a cesarean section. A low-dose combined sequential spinal-epidural anesthesia with invasive monitoring was used which provided excellent surgical condition with stable intraoperative and postoperative hemodynamics.

Low dose bupivacaine spinal anesthesia for emergency cesarean section in a patient with uncorrected tetralogy of fallot, presenting with placenta previa

“…Pregnancy is associated with reduced gastric emptying which rises the risk of aspiration while securing the airway. 4 Low-dose spinal anesthesia, on the other hand, prevents the risk of hypotension because the intensity of sympathetic block is minimal, so a decrease in SVR can be avoided. This technique can be used as an alternative to anesthesia in patients with tetralogy of Fallot, but it depends on the condition of the patient at the time of induction.…”