Extradural Analgesia in the Intrapartum Management of a Patient With Pulmonary Hypertension

Abstract

We describe the intrapartum management of a patient with severe pulmonary hypertension using extradural analgesia with a low dose of 0.125% bupivacaine and fentanyl 20 micrograms ml-1 by continuous infusion at a rate of 2.5 ml h-1. This provided effective analgesia and haemodynamic stability. The importance of continuous direct measurement of pulmonary artery pressure is emphasized.

The Effects of Oxytocin on the Pulmonary and Systemic Circulation in Pregnant Ewes

“…In previous human reports adverse responses to oxytocin have been noted with increased P Ap2.3 and when it was measured, increased PVR.l.4 This has been reported in women with primary pulmonary hypertension l . 3 and in a study of male patients with tuberculosis or bronchiectasis of varying severity.4 In this study, four out of fifteen patients had significant increases in PAP (5 mmHg) and PVR (20-40%) in response to ten to fifteen units of oxytocin infused over thirty minutes. 4 Oxytocin may exert these effects by direct actions on the pulmonary vasculature or by central effects with consequent neurally or humorally mediated pulmonary vasoconstriction.…”

Epidural Anesthesia for Cesarean Section in Atrial Septal Defect With Pulmonary Hypertension

“…3 Epidural analgesia not only avoids increase in PVR, it provides optimal analgesia in combination with controlled vasodilatation to accommodate autotransfusion. 8 Considering all above factors we successfully managed the case with epidural anaesthesia. Post-operative analgesia was provided with Tramadol given through the epidural catheter which provided stable cardiovascular situation.…”

Cesarean section and primary pulmonary hypertension: the role of intravenous dexmedetomidine

“…However, induction of labor is usually required which may lead to protracted labor and extensive stress requiring emergency cesarean section in an unfit patient. 12 Furthermore the drugs required to induce and augment labor may have detrimental effects on cardiovascular function.…”