Low-dose sequential combined spinal-epidural: an anaesthetic technique for caesarean section in patients with significant cardiac disease

Hamlyn, Eleanor; Douglass, Clifton; Plaat, F.; Crowhurst, John A.; Stocks, G.M.

doi:10.1016/j.ijoa.2005.01.001

Cited by 89 publications

(60 citation statements)

References 42 publications

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“…Various parameters, such as haemodynamic state of the parturients, the type of heart disease, use of medication and urgent or elective operation, should be taken into consideration while deciding on the anaesthesia method for pregnant women with heart disease (7). Whatever the underlying heart disease is, stage III-IV patients in accordance with the NYHA (New York Heart Association) classification are under higher risk (8,9).…”

Section: Introductionmentioning

confidence: 99%

The Evaluation of Applied Anaesthetic Techniques for Caesarean in Parturients with Cardiac Diseases: Retrospective Analysis

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et al. 2014

Turk J Anesth Reanim

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Objective: In this study, the effects of anaesthetic technique on mother and newborn were investigated in a retrospective analysis of parturients with cardiac diseases undergoing Caesarean section between 2006-2012.Methods: Our hospital's medical information system records were analyzed, and we found 107 parturients with cardiac disease and were undergoing Caesarean section, and their demographic data and obstetric, anaesthetic, and neonatal record forms were inspected.Results: Fifty-three (49.5%) pregnant women received general anaesthesia, and 54 (50.5%) received regional anaesthesia (34 spinal, 19 epidural and 1 CSE) (p=0.05). Week of pregnancy was lower for the group of general anaesthesia (p=0.007). Among cardiac parturients, valvular lesion rates were higher (75.7%). The relationship between existing cardiac disease and anaesthetic management was not significant (p=0.28). However, we determined that parturients with higher NYHA (New York Heart Association) classifications had higher general anaesthesia rates. (p=0.001). A rate of 39% of 74 NYHA I patients were undergoing general anaesthesia; this rate was 64% for NYHA II and 100% for NYHA III. The patients with cardiac surgery or medical treatment history had higher general anaesthesia rates (p=0.009). Although the general anaesthesia group newborn weights were lower (p=0.03), there was no difference between groups for APGAR scores. With regard to postoperative complications and hospital stay, the groups were similar. Conclusion:We determined that general and epidural rates in parturients with cardiac diseases were similar, general anaesthesia was preferred for parturients who had higher NYHA classifications and surgical or medical treatment history. We considered that general anaesthesia criteria should reduce the anaesthesia management of parturients with cardiac disease; epidural or CSE anaesthesia applications should increase according to the patient's physical state, haemodynamic parameters, and obstetric indications.

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Section: Introductionmentioning

confidence: 99%

The Evaluation of Applied Anaesthetic Techniques for Caesarean in Parturients with Cardiac Diseases: Retrospective Analysis

Yıldırım

Günüşen

Sargın

et al. 2014

Turk J Anesth Reanim

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“…Low dose combined spinal-epidural technique combines the reliability of intrathecal blockade with flexibility of epidural catheter to deliver a titrable and caridovascularly stable anaesthesia with provision of postoperative analgesia. 12 This technique was shown to be safe, effective and reliable with stable hemodynamics when compared with spinal anaesthesia for high risk geriatric patients undergoing major orthopaedic surgery. 13 Similarly, combined spinal epidural technique was found to provide superior analgesia and surgical conditions when compared with epidural tecnhique alone in another study enrolling patients undergoing major orthopaedic surgery.…”

Section: Discussionmentioning

confidence: 96%

Anaesthetic Management of a Patient with Dermatomyositis and Valvular Heart Disease

Shrestha

Aryal

2013

Kathmandu Univ. Med. J.

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Dermatomyositis is an idiopathic inflammatory myopathy with involvement of muscle, skin and other organs. Valvular heart disease increases the risk of perioperative adverse cardiac events. Only a little information is available about the anaesthetic management of a patient with dermatomyositis and valvular heart disease. Here we considered combined spinal-epidural technique for total abdominal hysterectomy, minimizing the risk of delayed recovery from muscle relaxants, aspiration pneumonitis, arrhythmias and cardiac failure.

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“…Therefore use of a slow acting local anesthetic in a slowly increasing doses while controlling the hemodynamic parameters helps the anesthesia settle more gradually and so provides better maintenance of cardiovascular stability. [7] In our patient levobupivacain is applied within 5 minute intervals. On the other hand, since the local anesthetic's clearance is low in many cardiac diseases, additional doses must be decreased.…”

Section: Discussionmentioning

confidence: 99%

The Application Of Epidural anesthesıa in Pregnant Woman With Uncorrected Tetralogy Of Fallot: A Case report

Solmaz¹

2015

Agri

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OCTOBER 2015215 ÖzetFallot tetralojisi en sık görülen siyanotik doğumsal kalp hastalığıdır. Bu hastalarda doğum sonrası meydana gelen ani hemodinamik değişiklikler ciddi, yaşamı tehdit eden multiorgan komplikasyonlarına yol açar. Bu yüzden anestezi seçimi zordur. Otuz üç haftalık düzeltilmemiş Fallot tetralojili gebe sezeryan operasyonuna alındı. Sorunsuz bir şekilde epidural anestezi uygulandı. Hastanın vital bulguları ve genel durumu stabil seyretti ve ameliyat sonrası yoğun bakımda dört gün takipten sonra kadın doğum servisine devredildi. Fallot tetralojili gebe hastada epidural anestezi uygulamasında bölünmüş ve artan dozlarda levobupivakain uygulamasının güvenli olduğu kanısındayız. Bununla birlikte, bizim bu verilerimiz klinik uygulama miktarının artırılması ile daha da güçleneceğini düşünüyoruz.Anahtar sözcükler: Sezeryan; Fallot tetralojisi; anestezi epidural. SummaryTetralogy of Fallot is the most common cyanotic congenital cardiac disease. The hemodynamic changes which are present immediately after abdominal delivery may be resulted with serious, life-threatening multiorgan complications. Therefore the choice of anesthesia is very difficult. We describe the case of pregnant, 33 weeks gestation, with uncorrected tetralogy of Fallot who underwent caesarian section. The epidural anesthesia was performed uneventfully. After having stabile vital signs and a good general condition patient was followed up at the intensive care unit for 4 days. She was transferred to the obstetric service. We think that application of epidural anaesthesia with fragmented and increasing doses of slow levobupivacain in pregnant women with tetralogy of Fallot is safe. Nonetheless, this data of ours will grow stronger with the increase of the clinical application amount.

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Low-dose sequential combined spinal-epidural: an anaesthetic technique for caesarean section in patients with significant cardiac disease

Cited by 89 publications

References 42 publications

The Evaluation of Applied Anaesthetic Techniques for Caesarean in Parturients with Cardiac Diseases: Retrospective Analysis

The Evaluation of Applied Anaesthetic Techniques for Caesarean in Parturients with Cardiac Diseases: Retrospective Analysis

Anaesthetic Management of a Patient with Dermatomyositis and Valvular Heart Disease

The Application Of Epidural anesthesıa in Pregnant Woman With Uncorrected Tetralogy Of Fallot: A Case report

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