We describe a case of a 29-year-oM Pregnancy is rare in patients with a single ventricle and transposition of the great arteries (TGA). Single ventricle anomalies occur in only 1.5 per cent of patients with congenital heart disease, and 80 per cent of these patients have TGA with an equal incidence of dextro-and laevo-malpositions. 1 Previously, pregnancy has been reported in only eight patients with a single ventricle with or without an associated TGA. 2-9 According to Mangano, ~~ in parturients with cyanotic congenital heart disease avoidance of regional anaesthetic techniques may be wise because a decreased systemic vascular resistance and/or venous return may worsen the right-to-left-shunt. This case presents the management of a parturient with a single ventricle and laevo-TGA. It is the first report of the use of lumbar epidural analgesia/anaesthesia with a local anaesthetic for labour, emergency Caesarean section, and postoperative pain. Case reportA 29-yr-old patient was admitted for induction of labour after an amniocentesis indicated fetal maturity. Her complex past medical history included cyanotic congenital heart disease. Five years before this admission, cardiac catheterization revealed a single ventricle, laevo-TGA, ventricular inversion, atrial septal defect, right atrioventricular valve atresia and mild subvalvular and valvular stenosis. Her single ventricle pressure was 120/10 mmHg with a mean pulmonary artery pressure of 15-20 mmHg and a normal pulmonary vascular resistance. Her haemoglobin oxygen saturations (SaOs) were: inferior vena cava and right atrium 75 per cent, left atrium and ventricle 87 per cent, aorta 88 per cent and pulmonary artery 86 per cent. The ventricular ejection fraction was 28 per cent, and the haematocrit (Hct) was 56 per cent. The patient never had hypercyanotic spells or congestive heart failure.Her obstetrical history included two spontaneous abortions six years before this admission and an uncomplicated successful pregnancy and vaginal delivery four years prior to admission. Throughout her previous pregnancy, the patient had a Hct of 55-60 per cent and an SaO2 of approximately 88 per cent. Labour was induced at 35 weeks gestation; the first stage lasted three hours with a fifteen-minute second stage. She delivered vaginally with CAN J ANAESTH 1990 / 37:6 /pp6S0-4
This is a report of a 39-year-old parturient who had a haemodynamically compromising venous air embolism during a repeatVenous air embolism is a potential hazard during any surgical procedure in which the operative site is above the level of the heart. ~ Air embolism during pregnancy, Caesarean section, and vaginal delivery has been detected by various methods. However, the incidence of significant parturient morbidity and mortality from air embolism is rare. We found no other reports in the Caesarean section literature of a haemodynamically compromising venous air embolism occurring immediately after skin incision nor were there any reports of the detection of such an event by precordiai ultrasonic Doppler monitoring.Case report A 39-year-old patient presented for repeat low flap Caesarean section for a transverse lying fetus. Her pregnancy was remarkable for chronic hypertension and the onset of primary hyperparathyroidism which required no treatment. Her medical history was positive for scoliosis, obesity (height 160 cm, weight 105 kg), a history of renal stones and a previous uncomplicated Caesarean section for failure to progress. Otherwise, her past medical history, physical examination and laboratory values were unremarkable. The patient's vital signs were: blood pressure (BP) 135/85 mmHg, heart rate (HR) 72 beats, min -~ and respiratory rate (RR) 16 breaths, min -t . After prehydration with two litres of Ringer's lactate, lumbar epidural anaesthesia was performed without complications using 0.5 per cent bupivicaine. The final level of anaesthesia was the fourth thoracic dermatome.The patient was placed on a level operating room table in the supine position with left uterine displacement. The intraoperative monitors included an automatic blood pressure monitor (Physio-Control VSM2), electrocardiogram, precordial stethoscope, pulse oximeter, precordial ultrasonic Doppler and a skin temperature monitor. Her vital signs were: BP 124/80 mmHg, HR 82 beats, min -t and RR 16 breaths.min -~. By pulse oximetry, her haemoglobin oxygen saturation was 100 per cent.Immediately after surgical incision was made, during surgery in the superficial subcutaneous tissues, there was CAN J ANAF.STH 1990 / 37 : 2 / pp 262-4
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