Aortic stenosis, cesarean delivery, and epidural anesthesia

Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis

“…Nevertheless, with close monitoring, careful titration of local anesthetic dose and pharmacological support, central neuraxial blocks have been used successfully in patients with aortic stenosis. 9,10 We chose to use a combined lumbosacral plexus block because it produces complete anesthesia of the ipsilateral lower limb effective for surgical repair of hip fracture 3 and the continuous lumbar plexus block provides postoperative analgesia. Lumbar plexus block also significantly reduces blood loss peroperatively 11 and postoperatively 12 when used to supplement normotensive general anesthesia for total hip arthroplasty, an advantage in patients with severe aortic stenosis since they tolerate hypovolemia poorly.…”

Noninvasive cardiac output monitoring during general anesthesia for Cesarean delivery in a patient with severe aortic stenosis

“…The effects of oxytocin administration on parturients with AS are not discussed in the majority of reports and reviews other than in cases where the associated vasodilation has caused an ill effect. 7 In summary, this case report suggests that pregnant women with AS may increase CO to compensate for vasodilation induced by anesthesia and oxytocin in the peripartum period. Furthermore, noninvasive continuous CO monitoring may contribute to our understanding of the peripartum hemodynamic changes in patients with AS and other cardiac lesions.…”

“…Careful review of previous studies where pulmonary artery catheters were used for intermittent CO monitoring suggests a rise in CO in patients with severe AS following both vaginal and Cesarean delivery. 8 Brian et al 7 detailed the hemodynamic changes in a pregnant woman with severe AS (transvalvular gradient 90 mmHg) undergoing Cesarean delivery with lumbar epidural anesthesia using a pulmonary artery catheter. They noted a decrease of 44% in systemic vascular resistance following oxytocin administration, with a subsequent net 21% increase in cardiac index, while HR remained unchanged.…”

“…The stenotic aortic valve limits blood leaving the heart and may lead to a relatively fixed cardiac output (CO). [1][2][3][4][5][6][7] General anesthesia is advocated for its cardiostable properties. 4 The safety of neuraxial anesthesia continues to be questioned, but recent case reports 3,7 and series 2,8 have documented its successful use in this highrisk patient group.…”

The Patient With Aortic Stenosis

“…The successful use of epidural anesthesia for labor and delivery, however, has been reported in multiple case reports. 22,45 The majority of the literature discussing neuroaxial techniques in parturients with AS is based on case reports. One such report by Brian et al showed no decrease in SVR after establishment of a T4 sensory level.…”