Anesthesia management for cesarean section 10 years after heart transplantation: a case report

Abstract

Introduction Pregnancy after organ transplantation is becoming increasingly common. However, reports of the anesthesia for such patients are rare. Heart transplant recipients are always accompanied with pathophysiological changes and present anesthesiologists with challenge.Case descriptionWe reported a case of anesthesia management of gravida undergoing cesarean section 10 years after cardiac transplantation. We used two points spinal and epidural anesthesia, combined with phenylephrine throughout the surgery. The course was absolutely successful and both mother and baby got good results.Discussion and evaluationPhysiology of heart transplant recipients and key points of anesthesia management were discussed.ConclusionsSpinal anesthesia can be performed in heart transplant recipients, however, we have to think twice before anesthesia for this kind of patients.

Spinal anaesthesia with intravenous sedation for total hip arthroplasty in two patients with a history of orthotopic heart transplantation

“…Intrathecal isobaric ropivacaine has been demonstrated to cause less hypotension compared to hyperbaric bupivacaine when administered for caesarean section in the obstetric population [7]. Bupivacaine and ropivacaine of varying baricity and doses have also been used with similar haemodynamic stability in the heart transplant recipient population [2][3][4][5]. It remains unclear how larger doses or additives (e.g.…”

“…Several small studies and case reports exist in the literature describing the use of neuraxial anaesthesia in patients who have previously undergone cardiac transplantation. These have reported the safe use of both isobaric and hyperbaric bupivacaine and the use of combined spinal epidural anaesthesia in a range of patient populations undergoing different types of surgery [2][3][4][5]. Only one of these reports explicitly mentions the use of procedural sedation with intravenous midazolam in addition to the neuraxial anaesthesia technique chosen [3].…”

Anesthetic Management for Heart Transplantation in Adults with Congenital Heart Disease

“…Regional anesthesia use for patients with a history of heart transplantation can be considered. This use has been successfully documented [23]. However, this should be reserved for patients who can tolerate the procedure given their potential anxiety.…”

Successful Pregnancy and Delivery Following Two Heart Transplantations

“…Advances in the field of transplant over recent decades have improved survival outcomes for post cardiac transplant patients. Approximately one third of heart transplant recipients are women and of those, approximately 20% are of reproductive age [1,2]. Obstetric management of the post cardiac transplant patient is a complex clinical scenario with increasing incidence as these women continue to desire childbearing following surgery.…”