Central neuraxial anesthesia for caesarean section in parturients with uncorrected tetralogy of fallot: Two cases

Baidya, Dalim Kumar; Dhir, R.; Dehran, Maya; Mahapatra, Bishnu P

doi:10.4103/2249-4472.99325

Cited by 9 publications

(15 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Regional anesthesia by neuraxial blockade usually decreases SVR so it is avoided, though there are some case reports of using graded epidural technique for anesthetic management of caesarean section in patients of TOF. 4 But as our patient had preeclampsia where decreased blood volume can cause drastic fall in BP and the platelet count was not known, we planned for GA.…”

Section: Discussionmentioning

confidence: 99%

“…1 The objective of anesthetic management mainly depends on maintaining of systemic vascular resistance and decreasing pulmonary vascular resistance and general anesthesia is recommended. 2,3,4 Preeclampsia is a very common multiorgan disorder of pregnancy. Previous studies on preeclamptic patients undergoing cesarean section recommends epidural anesthesia if coagulopathy is excluded.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A case of uncorrected tetralogy of Fallot with preeclampsia: an anesthetic challenge for cesarean section

Bhar

Maji

Das

et al. 2016

J. Soc. Anesth. Nep.

View full text Add to dashboard Cite

Women with cardiovascular diseases may present for cesarean delivery. We present a case of anesthetic management for cesarean section in a patient with uncorrected tetralogy of Fallot complicated with preeclampsia. No definite guideline or information is available in the textbook or literature about the management of such a case. A 21 year primigravida was admitted in our institute with breathlessness on normal day to day life activity. Her blood pressure was 160/100 mmHg, oxygen saturation 85-86% in room air and she had ejection systolic murmur of grade three intensity along the left sternal border. Her echocardiography which was done in the first trimester revealed tetralogy of Fallot with moderate to severe right ventricular outlet obstruction with hypoplastic pulmonary artery and pulmonary valve. Proteinurea was detected on bedside urine examination. The patient was posted for emergency cesarean section due to non-reassuring fetal heart rate associated with preeclamsia. Magnesium sulfate 10 gm intramuscularly was given for seizure prophylaxis and general anesthesia was administered using etomidate as induction agent. The objective of anesthetic management mainly depends on maintaining of systemic vascular resistance and decreasing pulmonary vascular resistance. In preeclampsia systemic vascular resistance is already elevated. Thus treatment of preeclampsia may worsen cyanosis, so we avoided labetalol to reduce blood pressure. Intra-operative and post-operative periods were uneventful and baby had good apgar scores. So we can conclude that cesarean section in patient with both tetralogy of Fallot and preeclampsia can be managed successfully with general anesthesia using techniques which maintain systemic vascular resistance.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A case of uncorrected tetralogy of Fallot with preeclampsia: an anesthetic challenge for cesarean section

Bhar

Maji

Das

et al. 2016

J. Soc. Anesth. Nep.

View full text Add to dashboard Cite

show abstract

“…Tehnik epidural juga dapat digunakan karena penurunan SVR tidak secepat jika dibandingkan dengan anestesi spinal. 5 Pada laporan kasus ini menggunakan tehnik anestesi low dose spinal dengan harapan tidak terjadi perubahan hemodinamik yang signifikan sehingga tidak terjadi perubahan shunt dari kanan ke kiri karena penurunan SVR.…”

Section: Pendahuluanunclassified

Low Dose Spinal Anesthesia Bupivakain 0,5% 5 mg dengan Adjuvan Fentanyl 50 mcg untuk Pasien dengan Uncorrected Tetralogy of Fallot yang Menjalani Seksio Sesarea

Hartono

Rahardjo

Uyun

2020

JAOI

View full text Add to dashboard Cite

Pasien hamil dengan uncorrected tetralogy of fallot yang menjalani seksio sesarea merupakan tantangan tersendiri bagi dokter anestesi. Tetralogy of Fallot terdiri dari ventricular septal defect, hipertrofi ventrikel kanan, overriding aorta dan stenosis pulmonal. Prinsip anestesi pada pasien ini adalah mempertahankan systemic vascular resistence (SVR) dan menghindari peningkatan pulmonary vascular resistance (PVR). Pasien Ibu hamil, 19 tahun dengan berat badan 50 kg, tinggi badan 150 cm, G3P000Ab200 Gravida 36–37 minggu, tunggal hidup, fetal distress dan tali pusat menumbung dengan tetralogy of fallot, akan dilakukan seksio sesarea cito. Penatalaksanaan anestesi pasien ini dengan low dose spinal anesthesia bupivakain 0,5% 5 mg dan adjuvan fentanyl 50 mcg. Hemodinamik stabil setelah tindakan spinal. Tekanan darah sebelum dilakukan spinal 100/60 mmHg dengan laju nadi 67 kali per menit dan saturasi oksigen 80% menggunakan non rebreathing mask (NRBM) 10 liter per menit. Tekanan darah pada saat operasi dimulai adalah 96/57 mmHg dan laju nadi 77 kali per menit serta saturasi 78% menggunakan NRBM 10 liter per menit. Setelah bayi dilahirkan, hemodinamik stabil hingga akhir operasi, tidak ditemukan periode hipotensi yang berat dan tidak digunakan obat vasopressor selama operasi. Pasien dipindahkan ke ICU untuk observasi pasca operasi selama 2 hari. Selama perawatan di ICU, kondisi pasien tetap stabil dan kemudian dipindahkan ke ruang perawatan biasa. Low dose spinal anesthesia mencegah risiko hipotensi karena intensitas blok simpatis yang lebih minimal sehingga penurunan SVR dapat dihindari. Teknik ini dapat digunakan sebagai alternatif pembiusan pada pasien dengan tetralogy of fallot tetapi tergantung kondisi pasien saat akan dilakukan pembiusan. Low Dose Spinal Anesthesia Bupivacaine 0,5% 5 mg with Adjuvant Fentanyl 50 mcg for Cesarean Section Patient with Uncorrected Tetralogy of Fallot AbstractCesarean delivery in parturient with uncorrected tetralogy of fallot poses significant challenge for anesthesiologist. Tetralogy of Fallot consists of ventricular septal defect, right ventricular hypertrophy, overriding aorta and stenosis pulmonum. Main principle of anesthesia for tetralogy of fallot is maintenance of systemic vascular resistance dan avoidance of increasing pulmonary vascular resistance. Parturient, 19 years old, body weigt 50 kg, height 150 cm, G3P000Ab200 36 – 37 weeks, fetal distress and umbilical cord prolapse with tetralogy of fallot will perform cesarean section. Patient anesthesized with low dose spinal anesthesia using bupivacaine 0,5% 5cmg with adjuvant fentanyl 50 mcg. Haemodynamic before spinal with blood pressure is 100/60 mmHg, heart rate 67 beat per minute (BPM), saturation is 80% using 10 liter of oxygen non rebreathing mask (NRBM) . Blood pressure during incision 96/57 mmHg heart rate 77 BPM with saturation 78% using 10 liter of NRBM. Haemodynamic is stable after baby is born until the operation is done, without any episode of severe hypotension and there is no using of vasopressor drugs. Patient is moved to ICU after the operation for further observation and for 2 days periode the haemodynamic is stable and then patient is moved to regular ward. Low dose spinal anesthesia avoid the incidence of hypotension by causing less intense blocked sympathetic system than traditional dose and thus providing a stable SVR. This technique could be an alternative for anesthesizing for parturient with tetralogy of fallot but its depend on patient condition before operation.

show abstract

“…Monitoring of arterial blood pressure can help in titrating epidural local anaesthetics and managing haemodynamic alterations, with the timely use of a vasopressor, and performing arterial blood gas analysis in case of worsening cyanosis or a cyanotic spell. [34]The authors mentioned about the ‘minimisation of sympathetic blockade by maintaining intravascular volume,’ but did not mention if any vasopressor was used or kept ready. Any degree of sympathetic blockade would decrease the SVR and could worsen the right-to-left shunt in such patients.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Labour analgesia and anaesthetic management of a primigravida with uncorrected pentalogy of fallot: Few concerns

2013

View full text Add to dashboard Cite

Central neuraxial anesthesia for caesarean section in parturients with uncorrected tetralogy of fallot: Two cases

Cited by 9 publications

References 7 publications

A case of uncorrected tetralogy of Fallot with preeclampsia: an anesthetic challenge for cesarean section

A case of uncorrected tetralogy of Fallot with preeclampsia: an anesthetic challenge for cesarean section

Low Dose Spinal Anesthesia Bupivakain 0,5% 5 mg dengan Adjuvan Fentanyl 50 mcg untuk Pasien dengan Uncorrected Tetralogy of Fallot yang Menjalani Seksio Sesarea

Labour analgesia and anaesthetic management of a primigravida with uncorrected pentalogy of fallot: Few concerns

Contact Info

Product

Resources

About