Anesthetic considerations for parturients with primary pulmonary hypertension: review of the literature and clinical presentation

Epidural Anesthesia for Cesarean Section in Atrial Septal Defect With Pulmonary Hypertension

“…The withdrawal of this pulmonary vasodilator effect of prostacyclin in immediate post-partum period may account for majority of deaths. 4 Normal Vaginal delivery can lead to increased mortality in early post-partum period, hence Johnson et al advocated elective caesarean section to prevent haemodynamic changes of labour and to spare fetus as well as the risk of hypoxaemia secondary to maternal physical exertion. 5 With careful epidural analgesia vaginal delivery can be successful, hence LSCS can be restricted to obstetric indications only.…”

Pregnancy and Pulmonary Arterial Hypertension

“…Inpatient monitoring is recommended in cases of worsening and prior to scheduled delivery (Kiely 2010). The optimal mode of delivery is not clear at this time but scheduled cesarean section with regional anesthesia has been used successfully in multiple case reports (Bédard 2009, Khan 1996, Stewart 2001, Goland 2010. The post partum period is the most critical time for worsening and death because of the rapid reversal of the physiologic hemodynamic changes of pregnancy.…”

“…The advantages of this approach are daytime scheduling and avoidance of marked hemodynamic changes that may occur with vaginal delivery and general anesthesia (Bonnin 2005, Kiely 2010). Regional anesthesia with cesarean section has been used successfully in several other reported cases (Bédard 2009, Khan 1996, Stewart 2001, Goland 2010. If epidural or spinal-epidural anesthesia is chosen, incrementally increasing epidural anesthesia is advocated to avoid rapid hemodynamic changes (Smedstad 1994).…”

Cesarean section and primary pulmonary hypertension: the role of intravenous dexmedetomidine

“…This can induce circulatory collapse in patients with PPH. 1 Regional anesthesia has been suggested to be advantageous, 14 but is not without problems. Blocks are contraindicated in anticoagulated patients and sympathetic blockade can cause significant hemodynamic instability.…”