Continuous spinal anesthesia for cesarean section in a parturient with severe recurrent peripartum cardiomyopathy

Veličković, Ivan; Leicht, Craig H.

doi:10.1016/s0959-289x(03)00052-9

Cited by 38 publications

(17 citation statements)

References 17 publications

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“…There have been favourable outcomes with both general and neuraxial anesthesia techniques, and there is lack of evidence showing difference in outcomes. [10][11][12] The rate of general anesthesia for Cesarean delivery in this cohort was 20% compared with 4% in our general obstetric population. Nevertheless, general anesthesia was reserved for cases of worsening heart failure, hemodynamic instability, difficulty tolerating the supine position, or failed neuraxial technique (patients #14 and #19).…”

Section: Discussionmentioning

confidence: 68%

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Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre

Ituk

Habib

Polin

et al. 2014

Can J Anesth/J Can Anesth

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Purpose This study examines the peripartum anesthetic management and outcomes of women with dilated cardiomyopathy in a large university medical centre over a seven-year period. Principal findings Twenty-five women were included in this series, 18 with a new diagnosis of cardiomyopathy and seven with a history of cardiomyopathy. Sixteen patients (64%) identified themselves as African American, seven (28%) were Caucasian, and two patients (8%) were Hispanic. The median (range) gestational age at the time of a new diagnosis of cardiomyopathy was 29 (7-38) weeks. Eight women (32%) had New York Heart Association class III/IV symptoms at the time of delivery or in the immediate postpartum period. A multidisciplinary team of obstetricians, anesthesiologists, cardiologists, and pediatricians were involved in the care of these women. The median (range) gestational age at the time of delivery was 33.5 (30-40) weeks. There were nine vaginal deliveries and 15 operative deliveries. One patient had fetal loss at 19 weeks gestation. Twelve women had labour induced with an intravenous infusion of oxytocin at a rate of 0.001-0.02 IUÁmin -1 . An oxytocin infusion at a variable rate with a maximum dose of 0.05 IUÁmin -1 was administered after vaginal delivery to maintain uterine tone. Epidural analgesia was initiated prior to induction of labour or in the latent phase of labour. Seven Cesarean deliveries were performed under combined spinal-epidural anesthesia, five were performed under epidural anesthesia, and three women had general anesthesia. Oxytocin was administered via an intravenous infusion at a rate of 0.05-0.2 IUÁmin -1 after operative delivery. One patient had a cardiac arrest on induction of general anesthesia and was successfully resuscitated. There were no maternal or neonatal deaths. Ten women were followed up at our institution and at six months postpartum; 50% of these patients were still symptomatic. Conclusion We report favourable outcomes in 25 pregnant women with dilated cardiomyopathy who were managed by a multidisciplinary team. Résumé

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Section: Discussionmentioning

confidence: 68%

“…[7][8][9] Literature on anesthetic management has been limited to individual case reports. [10][11][12] The purpose of this case series was to report on the peripartum anesthetic management and outcomes of women with dilated cardiomyopathy in a large university medical centre.…”

Section: Résumémentioning

confidence: 99%

Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre

Ituk

Habib

Polin

et al. 2014

Can J Anesth/J Can Anesth

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“…Any technique or drugs resulting in sudden fall in systemic vascular resistance should be avoided and careful titration of both intravenous and local anaesthetic drugs is important. Wherever possible, it is important to institute invasive monitoring including blood pressure and central venous pressure before commencement of anaesthesia 23,24 . In general, RA has been used in patients undergoing nonemergent caesarean section with relatively stable hemodynamic, while moderately symptomatic patients or parturient undergoing emergency surgery have received general anaesthesia (GA).…”

Section: Discussionmentioning

confidence: 99%

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

Saha¹,

Islam

Ahmed

et al. 2016

Birdem Med J

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Peripartum cardiomyopathy is a rare affliction of healthy, young, females characterized by congestive heart failure, intracardiac thrombus, and frequently death. PPCM is associated with a hypercoagulative state, which can cause thromboembolic complications, may be, the initial demonstration off peripartum cardiomyopathy, which is usually an intracardiac thrombosis. Lower extremity embolism is uncommon. We present a case of 22 yr old female a known case of preeclamtic toxaemia associated with bronchial asthma underwent caesarian section at 36 wks of pregnancy & developed severe respiratory distress and needed mechanical ventilation. Two weeks after delivery she developed low back pain with parasthesia of both lower limbs associated with shortness of breath & diagnosed as a case of infra-renal aortic thrombus extending down to common illiac arteries associated with postpartum dilated cardiomyopathy and admitted at our hospital for embolectomy. Infiltration anaesthesia and conscious sedation with invasive monitoring was planned. Surgery and anaesthesia proceeded uneventfully.

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“…But the major disadvantage after a dural puncture with an epidural needle is that post dural puncture headache can occur [9]. So we avoided CSA & decided to use single shot spinal anaesthesia using low dose bupivacaine with fentanyl.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of peripartum cardiomyopathy for emergency caesarean section: A case report

Bansal¹,

Hooda²

2014

CMJ

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Peripartum cardiomyopathy is a rare but life threatening condition. Anaesthetic management of a patient with peripartum cardiomyopathy for caesarean section is a major challenge for anaesthesiologist. Timely diagnosis of the condition, institution of appropriate medication regimen, a carefully chosen anaesthetic technique and vigilant perioperative monitoring are essential for optimizing outcome in these patients. The goals of anaesthetic management include maintenance of optimal ventricular preload and afterload while avoiding any anaesthesia induced myocardial depression. Keywords: Peripartum cardiomyopathy, caesarean secion, anaesthetic management ÖzetPeripartum kardiyomyopati nadir ancak yaşamı tehdit eden bir durumdur. Peripartum kardiyomyopatisi olan bir hastanın sezaryen ameliyatı için anestezisinin yönetimi anestezist açısından önemli bir sorundur.Durumun vaktinde tanı alması, uygun tedavi rejiminin oluşturulması, dikkatlice seçilmiş anestezi tekniği ve dikkatli perioperatif monitorizasyon uygulanması bu hastaların tedavi sonuçlarının en iyi hale getirilmesi açısından önemlidir.Anestezi yönetiminin hedefleri optimal ventriküler preload ve afterload sağlarken anestezinin indüklediği herhangi bir myokardiyal depresyondan kaçınmaktır.Anahtar sözcükler: Peripartum kardiyomiyopati, sezaryen, anestezi yönetimi Geliş tarihi

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Continuous spinal anesthesia for cesarean section in a parturient with severe recurrent peripartum cardiomyopathy

Cited by 38 publications

References 17 publications

Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre

Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre

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

Anaesthetic management of peripartum cardiomyopathy for emergency caesarean section: A case report

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