Low-dose sequential combined-spinal epidural anesthesia for Cesarean section in patient with uncorrected tetrology of Fallot

Solanki, Sohan Lal; Jain, Amit; Singh, Amanjot; Sharma, Arun

doi:10.4103/1658-354x.84111

Cited by 19 publications

(24 citation statements)

References 4 publications

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“…In this case, where regional anaesthesia was not successfully placed, general anaesthesia was implemented. General anaesthesia is associated with several challenges in these patients; many of the agents used for induction and maintenance of general anaesthesia decreases the SVR with a potential of causing more right-to-left shunting through the VSD and there is risk of adverse haemodynamic responses associated with laryngoscopy and intubation that may lead to decompensation in these patients with reduced cardiac reserve 18. Phenylephrine was used as vasopressor in this case in anticipation of the drop in SVR caused by general anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Multiple pregnancy in a primigravida with uncorrected Pentalogy of Fallot

Partana

Tan

et al. 2017

BMJ Case Reports

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Pentalogy of Fallot is a cyanotic congenital heart disease that has guarded prognosis without surgical intervention in infancy. Women with uncorrected defects rarely survive into childbearing age and pregnancy in this group is associated with a high rate of perinatal loss. Physiological cardiovascular changes in pregnancy can lead to maternal haemodynamic instability with subsequent adverse cardiac sequelae with or without fetal decompensation. Optimum management and pregnancy outcomes in mother with uncorrected Pentalogy of Fallot and twin pregnancy have not been described in the literature. We describe a successful case of monochorionic diamniotic twin pregnancy in an affected woman who has not undergone surgical repair. Her pregnancy progressed without any adverse cardiopulmonary complications. Her caesarean delivery and postpartum recovery were favourable, with successful birth of two healthy babies at 35.7 weeks. This case emphasises the importance of a multidisciplinary team, especially of obstetricians with expertise in high-risk pregnancies, adult congenital heart disease cardiologists and anaesthesiologist.

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Section: Discussionmentioning

confidence: 99%

Multiple pregnancy in a primigravida with uncorrected Pentalogy of Fallot

Partana

Tan

et al. 2017

BMJ Case Reports

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“…When anesthetizing patients with congenital heart disease, under either a regional technique or general anesthesia, the following factors must be kept in mind; prevention of accidental intravenous infusion of air bubbles by using loss of resistance to saline rather than air to identify the epidural space, 9 a slow onset of epidural analgesia is useful, as rapid fall in SVR could result in reversal of shunt. [14][15][16] Supplemental O2 should be given to the patient throughout the procedure if regional technique is used. It is advisable to monitor O2 saturation as mild hypoxaemia may result in an increase in PVR and reversal of shunt flow.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic Management of an Adult Patient With Uncorrected Ventricular Septal Defect Posted for Obstructed Inguinal Hernia Repair

Shivaramu¹,

Mishra²,

S³

2015

jemds

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Adults with unrepaired acyanotic heart disease scheduled for a non-cardiac surgery present serious concerns for the anaesthesiologists. Ventricular septal defect (VSD), is an acyanotic congenital heart disease, characterized by a left to right shunt. The incidence varies between 2 to 6 per 1000 live births. It is found in 30% to 60% of all the newborns with congenital heart disease, thus making it one of the most common congenital heart diseases VSD is the commonest form of CHD. Unlike ASD, the majority will undergo spontaneous closure: 40% by the age of 2yr and 90% by the age of 10 yr. 1 The goal of anesthetic management should be to maintain intravascular volume. Systemic and pulmonary vascular resistance changes, such as might occur due to acidosis, hypothermia, hypercarbia or excessive airway pressures, should be avoided. Maintenance of preload, contractility and sinus rhythm is of major importance. The complex pathophysiologies of such heart disease, in addition to the circumstances of emergency operation, exacerbate the total anesthetic risk. We present here a rare case of obstructed right sided inguinal hernia repair with successful outcome in an adult with ventricular septal defect.

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“…There are case reports indicating the successful use of epidural, combined spinal epidural and continuous spinal anaesthesia in pregnant women with serious cardiovascular disease (7,9,10). It was reported that epidural anaesthesia effectively decreases birth-associated cardiac output increase and vascular wall tension (6).…”

Section: Discussionmentioning

confidence: 99%

“…Solanki et al (10) in a pregnant woman with cardiovascular risk, performed combined spinal epidural anaesthesia for caesarean section using 0.5 mL 0.5% hyperbaric bupivacaine and 25 μg fentanyl. As the level of sensory block remained at T10, an additional dose of 3 mL and 2 mL of 0.5% bupivacaine and 100 μg fentanyl was infused from the epidural catheter intermittently; they reported that the patient's hemodynamic status, who was given prophylactic phenylephrine infusion, remained stable.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia for Caesarean Delivery in a Pregnant with Acute Type B Aortic Dissection

Kayhan¹,

Gülhaş²,

Şahin³

et al. 2013

Turk J Anesth Reanim

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Case Report 178About 50% of aortic dissections in women younger than 40 years occur during pregnancy; mostly in the 3rd trimesters and postpartum period. Aortic dissection in pregnancy creates a serious mortality risk for both mother and the foetus. The ultimate goal is to ensure the safety of both the mother and the foetus. In such cases, the best method of anaesthesia for caesarean delivery is still controversial. The first aim of anaesthetic management is to reduce the effect of cardiovascular instability on the dissected aorta. Here, we report the anaesthetic management of a 36 year-old pregnant woman who developed acute type B aortic dissection in the 30 th gestational weeks and scheduled for caesarean section. Since hemodynamic stability could not be achieved despite nitro-glycerine and esmolol infusions, together with invasive arterial monitoring, the decision for caesarean delivery was taken. A team of Cardiovascular Surgeons and an operating room were prepared because of the risks of aortic rupture and hemodynamic collapse during operation. Combined-spinal epidural anaesthesia was administered using 5 mg hyperbaric bupivacaine and 20 μg fentanyl given at the L3-4 spinal level in the side lying position. After achieving T4 sensory block level, the operation proceeded and a baby weighing 1432 grams was delivered in 4 min with a median subumbilical incision. Epidural patient controlled analgesia was applied to the patient during follow-up with medical treatment at postoperative period. In pregnant women with acute Type B aortic dissection, if adequate sensory block level cannot be achieved despite using a combination of low dose local anaesthetic (spinal use) and opioids, we are in the opinion that combined spinal-epidural anaesthesia, which allows the use of additional doses can be a decent choice.

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Low-dose sequential combined-spinal epidural anesthesia for Cesarean section in patient with uncorrected tetrology of Fallot

Cited by 19 publications

References 4 publications

Multiple pregnancy in a primigravida with uncorrected Pentalogy of Fallot

Multiple pregnancy in a primigravida with uncorrected Pentalogy of Fallot

Anaesthetic Management of an Adult Patient With Uncorrected Ventricular Septal Defect Posted for Obstructed Inguinal Hernia Repair

Anaesthesia for Caesarean Delivery in a Pregnant with Acute Type B Aortic Dissection

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