Low dose combined spinal-epidural anaesthesia for caesarean section in a patient with peripartum cardiomyopathy

Pirlet, Martine; Baird, Michael G.; Pryn, S. J.; Jones-Ritson, M.; Kinsella, Stephen

doi:10.1054/ijoa.1999.0374

Cited by 19 publications

(16 citation statements)

References 16 publications

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“…Caution must be taken to avoid sudden sympathetic blockade. Spinal or combined spinalepidural anesthesia (with or without caesarean section) with the use of spinal opioids rather than spinal local anesthetics, has been suggested to provide adequate analgesia with less hemodynamic instability (88)(89)(90). Other anesthetic or obstetrical issues are discussed in detail elsewhere (91,92).…”

Section: Pregnancy and Chronic Cardiovascular Diseasementioning

confidence: 99%

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Howlett¹,

McKelvie²,

Costigan³

et al. 2010

Canadian Journal of Cardiology

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Section: Pregnancy and Chronic Cardiovascular Diseasementioning

confidence: 99%

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Howlett¹,

McKelvie²,

Costigan³

et al. 2010

Canadian Journal of Cardiology

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“…Pirlet et al described another patient managed with regional anesthesia. 7 This patient had an EF of 13%, which improved to 20% with medical management, and was brought for semi-urgent delivery by Cesarean section. She was monitored with pulmonary artery catheterization preinduction, and was then given 5 mg intrathecal hyperbaric bupivacaine.…”

mentioning

confidence: 97%

Peripartum cardiomyopathy and thromboembolism; anesthetic management and clinical course of an obese, diabetic patient

Kaufman

Bondy

Benjamin

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To describe the anesthetic management and clinical course of a patient with peripartum cardiomyopathy. We highlight the frequent occurrence of thromboembolic morbidity in this group of parturients, emphasizing the need for early consideration of prophylactic anticoagulation.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 38-yr-old, diabetic, obese parturient was admitted with pulmonary edema and severe orthopnea at 31 weeks gestation. The respiratory rate was 44 breaths·min and rales were heard in both lung fields. The diagnosis of peripartum cardiomyopathy was made based on sinus tachycardia with no evidence of ischemia on the electrocardiogram, and global left ventricular hypokinesis with an ejection fraction of 40-45% noted on transthoracic echocardiography. Cesarean delivery was planned to improve maternal respiratory status and hemodynamics. General anesthesia with invasive monitoring was planned, and surgery and anesthesia proceeded uneventfully. Less than 24 hr postoperatively, she sustained a thrombotic cerebral infarct leaving her hemiparetic and dysarthric. Subsequent investigations revealed a thrombophilic state due to elevated anticardiolipin antibody.C Co on nc cl lu us si io on n: : General anesthesia is an acceptable option in parturients with heart failure secondary to cardiomyopathy. Thromboembolic complications are common, and early consideration should be given to prophylactic anticoagulation. Objectif

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“…Low-dose sequential CSE has been used successfully for caesarean section in many cases of cardiac disease but, to our knowledge, not in Eisenmenger's syndrome. [25][26][27][28][29] For our patient 5 mg of hyperbaric bupivacaine was sufficient to achieve a block to T4 and the epidural catheter was therefore not used during the caesarean section. The high inter-individual variability of intrathecal drug spread, notably during pregnancy, may account for this.…”

Section: Discussionmentioning

confidence: 95%

Low-dose combined spinal-epidural anaesthesia for caesarean section in a patient with Eisenmenger’s syndrome

Parneix

Fanou

Morau

et al. 2009

International Journal of Obstetric Anesthesia

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Low dose combined spinal-epidural anaesthesia for caesarean section in a patient with peripartum cardiomyopathy

Cited by 19 publications

References 16 publications

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Peripartum cardiomyopathy and thromboembolism; anesthetic management and clinical course of an obese, diabetic patient

Low-dose combined spinal-epidural anaesthesia for caesarean section in a patient with Eisenmenger’s syndrome

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