Hypertrophic cardiomyopathy and caesarean section: intraoperative use of transthoracic echocardiography

Ferguson, Eric; Paech, Michael J.; Veltman, Michael

doi:10.1016/j.ijoa.2005.08.008

Cited by 19 publications

(6 citation statements)

References 15 publications

(15 reference statements)

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“…Significant LVH does increase the risk associated with surgical procedures but, with TEE to monitor for early signs of dynamic outflow obstruction, successful outcomes can be achieved [17,18]. The utilization of pocket-sized handheld ultrasound devices may help clinicians identify patients with undiagnosed cardiac conditions before unexpected emergency situations arise during elective surgeries.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Arrest Due to Severe Dynamic Left Ventricular Outﬂow Obstruction and Hypertrophy Following Anesthesia Induction

Harrison

Feinglass²,

Festić³

2020

Signa Vitae

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Cardiac arrest following induction of general anesthesia is a rare event. A 47-year-old woman with a history of chronic neck pain secondary to spinal stenosis presented for elective cervical laminectomy. Induction of general anesthesia induced cardiac arrest and emergency insertion of the transesophageal echocardiogram probe identified severe, undiagnosed left ventricular hypertrophy with dynamic outflow obstruction. Resuscitative treatment was immediately implemented to include aggressive intravenous fluid resuscitation, intravenous esmolol and phenylephrine to augment preload, afterload, and reflex bradycardia effect. Return of spontaneous circulation was achieved and the patient was admitted to the ICU, where she was extubated with preserved neurocognitive function on the same day. Our case describes the risk presented by undiagnosed cardiac abnormalities in what was accepted as a low-to-intermediate risk patient undergoing an elective procedure. The increasing popularity and use of pocket-sized handheld ultrasound devices may help reduce the risk of occurrences such as this in the future.

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Section: Discussionmentioning

confidence: 99%

Cardiac Arrest Due to Severe Dynamic Left Ventricular Outﬂow Obstruction and Hypertrophy Following Anesthesia Induction

Harrison

Feinglass²,

Festić³

2020

Signa Vitae

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“…Non-invasive monitoring with 2D echo and continuous ECG can be effectively accomplished when needed. 8 Oxytocin can induce vasodilatation so it should only be given as slow intravenous infusion. 2 The dose should be kept to minimum (5 units) to avoid side-effects of hypotension, tachycardia and arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy with Hypertrophic Cardiomyopathy – A Potential Risk Factor for Maternal Mortality

Kumare

Kawthalkar

2015

Kathmandu Univ. Med. J.

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We report a case of a 21 year old married woman diagnosed to have severe hypertrophic cardiomyopathy at 12 weeks of gestation by echocardiograph at Lata Mangeshkar Hospital, Nagpur on 12th June, 2012. Her mother’s and maternal uncle’s sudden death at young age along with severe form of disease brought a lot of apprehension in the beginning considering the possible catastrophic effect of hemodynamic changes associated with pregnancy and labor. She was asymptomatic before pregnancy but developed dyspnoea on exertion during pregnancy and hence was started on calcium channel blocker verapamil. She remained asymptomatic throughout pregnancy and later underwent elective caesarean section at term under epidural anaesthesia for major cephalopelvic disproportion with uneventful postoperative course. Current data on pregnancy outcome in Hypertrophic cardiomyopathy are limited in Southasian countries despite its high prevalence in general population. This case report illustrates that with favourable clinical profile and specialist multidisciplinary team management women with hypertrophic cardiomyopathy tolerate pregnancy well with good outcome.Kathmandu Univ Med J 2013; 11(4): 335-337

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“…It is comforting to know that uterine massage may often be adequate in achieving uterine contraction and that a small dose of oxytocin, given very slowly, is likely to contract the uterus. Nevertheless, severe haemodynamic disturbances may still occur 31 .…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Oxytocin Dosing at Caesarean Section

Stephens

Bruessel

2012

Anaesth Intensive Care

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We undertook a systematic review to determine the optimal dose of oxytocin after elective caesarean section or caesarean section in labouring women. We identified seven trials. These trials raise questions about the use of high dose (10 international units; IU) or moderate dose (5 IU) oxytocin in both settings and provide evidence that lower doses are equally effective but associated with significantly fewer side-effects. For elective caesarean section, a slow 0.3 to 1 IU bolus of oxytocin over one minute, followed by an infusion of 5 to 10 IU.h−1 for four hours represents an evidence-based approach to dosing for women at low risk of postpartum haemorrhage. For the labouring parturient a slow 3 IU bolus of oxytocin, followed by an infusion of 5 to 10 IU.h−1 for four hours is supported by limited evidence. These doses represent a starting point in the control of postpartum haemorrhage after caesarean section and do not reduce the need for mandatory active observation of the clinical situation, to detect situations that require additional doses of oxytocin or other uterotonic drugs. These doses of oxytocin minimise the risk of adverse haemodynamic changes as well as the unpleasant side-effect of nausea.

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Hypertrophic cardiomyopathy and caesarean section: intraoperative use of transthoracic echocardiography

Cited by 19 publications

References 15 publications

Cardiac Arrest Due to Severe Dynamic Left Ventricular Outﬂow Obstruction and Hypertrophy Following Anesthesia Induction

Cardiac Arrest Due to Severe Dynamic Left Ventricular Outﬂow Obstruction and Hypertrophy Following Anesthesia Induction

Pregnancy with Hypertrophic Cardiomyopathy – A Potential Risk Factor for Maternal Mortality

Systematic Review of Oxytocin Dosing at Caesarean Section

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