A Case Series of the Anesthetic Management of Parturients with Surgically Repaired Tetralogy of Fallot

Arendt, Katherine W.; Fernandes, Susan M.; Khairy, Paul; Warnes, Carole A.; Rose, Carl H.; Landzberg, Michael J.; Craigo, Paula; Hebl, James R.

doi:10.1213/ane.0b013e31821ad83e

Cited by 21 publications

(11 citation statements)

References 31 publications

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“…However, a surprisingly limited number of these publications actually dwell on the anesthetic management of these high-risk parturients presenting for labor and delivery. A recent case series dealt with the anesthetic management and pregnancy outcomes of parturients with surgically repaired TOF,[3] but such data for unrepaired TOF are scanty. These patients with unrepaired TOF could become pregnant, are at increased risk of fetal loss, have greater incidences of fetal malformations and more chances of developing adverse outcomes such as cardiac failure, arrhythmias and reduced contractile function of the right ventricle in addition to the risks of cyanosis and cyanotic spells.…”

Section: Discussionmentioning

confidence: 99%

Spinal anesthetic for emergency cesarean section in a parturient with uncorrected tetralogy of Fallot, presenting with abruptio placentae and gestational hypertension

Adinarayanan

Parida

Jayaram

et al. 2014

J Anaesthesiol Clin Pharmacol

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A subarachnoid block is an effective way of providing anesthesia for cesarean sections. However, it can be considered relatively contra-indicated in parturients with uncorrected tetralogy of Fallot (TOF). We report a case of a 22-year-old female patient with TOF and gestational hypertension, who presented for an emergency cesarean section for placental abruption. The surgery was successfully conducted under a spinal anesthetic with a combination of low dose bupivacaine and fentanyl. Fentanyl combined with small-dose bupivacaine in the subarachnoid space can be considered as an alternative technique to general anesthesia, in selected parturients with uncorrected TOF presenting for cesarean section, especially in cases where the risks of administering a general anesthetic are deemed high.

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Section: Discussionmentioning

confidence: 99%

Spinal anesthetic for emergency cesarean section in a parturient with uncorrected tetralogy of Fallot, presenting with abruptio placentae and gestational hypertension

Adinarayanan

Parida

Jayaram

et al. 2014

J Anaesthesiol Clin Pharmacol

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“…2 Epidural analgesia is recommended for labour, and loss of resistance to saline is utilized to avoid accidental air embolism. 11 The effective sympathectomy minimizes hemodynamic fluctuations related to catecholamine surges; however, careful titration of epidural analgesia is required to avoid significant decreases in preload and afterload. A passive second stage and instrumental delivery is preferred in most women.…”

Section: Discussionmentioning

confidence: 99%

“…1 The hematocrit should be kept close to preoperative levels, and invasive BP monitoring is performed in the contralateral arm to the BTS. 11 Central venous line insertion may be problematic due to previous surgical reconstruction or anatomic abnormalities. 9 An air bubble trap is advisable to prevent paradoxical air embolism, and uterotonic agents should be administered slowly to avoid hemodynamic instability.…”

Section: Discussionmentioning

confidence: 99%

Cardiac output monitoring during Cesarean delivery in a patient with palliated tetralogy of Fallot

Clivatti

Smith

Sermer

et al. 2012

Can J Anesth/J Can Anesth

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Purpose Tetralogy of Fallot (TOF) is one of the most common causes of cyanotic congenital heart disease. The anesthetic management of parturients with uncorrected TOF is challenging and controversial, especially for Cesarean delivery (CD). We describe the use of noninvasive cardiac output (CO) monitoring to assist the management of CD for a woman with palliated TOF under general anesthesia. Clinical features A 34-yr-old woman presented for elective CD at 38 weeks gestation. Having been born with TOF, she underwent a modified Blalock-Taussig shunt at six years of age, followed nine years later by creation of an aortopulmonary connection. The patient's functional status was New York Heart Association class I despite evident central cyanosis. A CD was performed under general anesthesia. Fentanyl, etomidate, and succinylcholine were utilized for induction, and intrathecal morphine was administered for postoperative pain control. The baseline CO (7.2 LÁmin -1 ), blood pressure (156/74 mmHg), heart rate (74 beatsÁmin -1 ), and total peripheral resistance (1,059 dynesÁsec -1 Ácm -5 ) remained stable throughout the procedure. Maintenance anesthesia consisted of rocuronium, sevoflurane, and an oxygen/nitrous oxide mixture. Upon delivery, an infusion of oxytocin combined with ergometrine was administered. Hemodynamic parameters remained stable and no vasopressor was required. Conclusion Balanced general anesthesia and careful titration of uterotonic agents provided stable hemodynamic conditions during CD in a patient with a palliated TOF, as assessed by a continuous noninvasive CO monitor. Noninvasive CO monitoring may improve our understanding of the hemodynamic implications of various anesthetic techniques for CD in cardiac patients. RésuméObjectif La te´tralogie de Fallot (TF) est l'une des causes les plus fre´quentes de cardiopathie conge´nitale cyanosante. La prise en charge anesthe´sique des parturientes ayant une TF non corrige´e est controverse´e et rele`ve du de´fi, en particulier en cas d'accouchement par ce´sarienne. Nous de´crivons l'utilisation d'un monitorage non invasif du de´bit cardiaque (DC) pour aider la prise en charge de la ce´sarienne chez une femme ayant une TF ope´re´e sous anesthe´sie ge´ne´rale. Caractéristiques cliniques Une femme aˆge´e de 34 ans se pre´sente pour une ce´sarienne programme´e à 38 semaines de grossesse. Elle est ne´e avec une TF et a subi une intervention modifie´e de Blalock-Taussig a`l'aˆge de six ans, puis neuf ans plus tard la cre´ation d'une connexion aorto-pulmonaire. Le statut fonctionnel de la patiente

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“…The safety of low-dose sequential CSE analgesia in women with unrepaired cyanotic heart disease who required analgesia for labor has recently been reported (Arendt et al, 2011) [C].…”

Section: Cse Anesthesia In Special Populationsmentioning

confidence: 99%

“…In addition, CSE can be a good option in pregnant women with a variety of serious medical conditions: CSE anesthesia or analgesia was successfully used in a parturient with severe myasthenia gravis (D'Angelo and Gerancher, 1998), idiopathic hypertrophic sub-aortic stenosis (Ho et al, 1997), mitral stenosis (Ngan Kee et al, 1999), dilated cardiomyopathy (Shnaider et al, 2001), Guillain-Barre syndrome (Vassiliev et al, 2001), Laron syndrome (Bhatia and Cockerham, 2011), tetralogy of Fallot (Arendt et al, 2011), Liddle's syndrome (Hayes et al, 2011), Wegener's granulomatosis with subglottic stenosis (Engel et al, 2011).…”

Section: Cse Anesthesia In Obstetricsmentioning

confidence: 99%

Combined Spinal Epidural Anesthesia and Analgesia

Stamenković¹,

Καρανικόλας²

2012

Epidural Analgesia - Current Views and Approaches

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A Case Series of the Anesthetic Management of Parturients with Surgically Repaired Tetralogy of Fallot

Cited by 21 publications

References 31 publications

Spinal anesthetic for emergency cesarean section in a parturient with uncorrected tetralogy of Fallot, presenting with abruptio placentae and gestational hypertension

Spinal anesthetic for emergency cesarean section in a parturient with uncorrected tetralogy of Fallot, presenting with abruptio placentae and gestational hypertension

Cardiac output monitoring during Cesarean delivery in a patient with palliated tetralogy of Fallot

Combined Spinal Epidural Anesthesia and Analgesia

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