Case Report and Mini Literature Review: Anesthetic Management for Severe Peripartum Cardiomyopathy Complicated with Preeclampsia Using Sufetanil in Combined Spinal Epidural Anesthesia

Abstract

Peripartum cardiomyopathy (PPCM) is a rare entity, and anesthetic management for cesarean section of a patient with this condition can be challenging. We hereby present the anesthetic management of a patient with PPCM complicated with preeclampsia scheduled for cesarean section, along with a mini review of literature. A 24 year-old primigravida with twin gestation was admitted to our hospital with severe PPCM and preeclampsia for peripartum care, which finally required a cesarean section. Preoperative optimization was done according to the goal of managing left ventricular failure. Combined spinal epidural (CSE) anaesthesia with bupivacaine and sufentanil was used for cesarean section under optimal monitoring. The surgery was completed without event or complication. Postoperative pain relief was adequate and patient required only one epidural top up with sufentanil 6 hours after operation. To the best of our knowledge there is no report in literature of the use of sufentanil as a neuraxial opioid in the anesthetic management of cesarean section in a patient with PPCM. CSE with sufentanil may be a safer and more effective alternative in such cases.

Establishment of an Animal Model of Epidural Anesthesia and Sedative Tail-Flick Test for Evaluating Local Anesthetic Effects in Rats

“…Therefore, the catheter insertion method in our model is less invasive. The fact that this method of dosing already has clinical applications [2,13] indicates that dosing into the epidural space via an indwelling catheter is effective for evaluating the clinical effect of local anesthetics. epidural anesthesia blocks the spinal root domain in the epidural space, which includes loose connective tissue, lipids, and the batson venous plexus [10].…”

Anaesthetic Management of a Patient with Peripartum Cardiomyopathy: A Case Report

“…10 The exact etiology of PPCM remains is unknown, but viral, autoimmune, hemodynamic stress of pregnancy, cytokine mediated inflammation, Gqrelated myocyte apoptosis, oxidative stress-induced Cathepsin D production, selenium deficiency, and idiopathic causes are being hypothesized. 10,11,12,13 Other possible etiologies include nutritional deficiencies, small-vessel coronary artery disease, excessive salt intake, and peripartum fluid shifts 14 . Maternal age more than 30 years, multiparity, eclampsia, obesity, racial origin (African descent), hypertension, malnutrition, and prolonged tocolysis are predisposing factors.…”

“…3 A vigilant monitoring both noninvasive and invasive is essential through out the surgery and in the postoperative period to avoid complications like arrhythmias (atrial fibrillation), hypotension, hypoxemia, pulmonary edema, electrolyte disturbances, myocardial ischemia, thromboembolism, and even sudden death. 1,2,3,4,5,6 Acute limb-threatening lower extremity ischemia is uncommon in young adults with no prior symptoms of arterial insufficiency or risk factors for atherosclerotic occlusive disease. Peripartum cardiomyopathy is a rare affliction of healthy, young, females characterized by congestive heart failure, intracardiac thrombus, and frequently death.…”

Delayed peripartum cardiomyopathy after emergency cesarean section

“…Peripartum cardiomyopathy (PPCM) is a primary myocardial disease without any demonstrable cause and with onset in the last month of pregnancy or within six months of delivery [1]. Mortality is as high as 20 to 50% [2].…”

“…The clinical features of PPCM include symptoms of congestive heart failure and chest pain [1]. Signs can include hypertension, tachycardia, tachypnea, pulmonary rales, S 3 heart sound and pedal edema.…”