Anesthetic Management in Peripartum Cardiomyopathy: A Contemporary Review

Abstract

Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is linked to high rates of morbidity and mortality. It is an idiopathic condition characterized by left ventricular systolic dysfunction with an ejection fraction of approximately 45% near the end of pregnancy or immediately after delivery. Anesthesia management in these women is challenging due to low physiological reserve and potential negative effects on the fetus. To ensure that mother and child are supported safely through delivery, careful anesthesia control is required. Here, in this review article, we discuss the anesthetic implications in preoperative, operative, and postoperative phases in women with perioperative cardiomyopathy undergoing vaginal delivery or cesarean section.

Anesthetic management of a patient with pheochromocytoma and peripartum cardiomyopathy for cesarean section

“…Pheochromocytoma can be one of the causes of dilated cardiomyopathy. 7 Regarding clinical presentation, orthopnea and paroxysmal nocturnal dyspnea is more specific. 8 Electrocardiograph and echocardiography confirms the diagnosis.…”

“…Goal is to avoid tachycardia and arrhythmias. 7 In addition to standard ASA monitoring, urine output and invasive blood pressure monitoring is essential.…”

“…Whereas, spinal anesthesia can lead to sudden hypotension and patient with peripartum cardiomyopathy cannot compensate for it. 7 Intraoperatively, blood pressure must be controlled with short acting antihypertensives like phentolamine, nitroglycerine and magnesium sulphate. 5 Uterotonic oxytocin must be used cautiously as it causes vasodilation and tachycardia.…”

An Empirical Study of Factors Contributing to International Patients Satisfaction with Special Reference to Medical Tourism in India

“…Patient satisfaction, on the other hand, is defined as a degree of consistency between patients' expectations of ideal treatment and their assessments of the actual care they have delivered, as documented by a few writers. (51). The satisfaction model can be divided basically into four groups, including Strong selflessness, Spurious Stuff, Latent delights, and Small congratulations (52).…”