Perioperative management of emergent cesarean section in a patient with peripartum cardiomyopathy and orthopnea: a case report

Abstract

Perioperative management of pregnant women with heart failure is difficult. Management of anesthesia in pregnant women is especially difficult because all of the currently available choices present challenges. We report a patient with peripartum cardiomyopathy (PPCM) who required an emergent cesarean section and discuss the possible tactics for managing anesthesia. A 40-year-old primipara with severe cardiac and respiratory failure required an emergent cesarean section at 39+1 gestational weeks. Her left ventricular ejection fraction was between 10% and 15%, and she had orthopnea. General anesthesia was planned after inserting sheaths for percutaneous cardiopulmonary support from the femoral artery and vein. However, when the patient was asked to lie down on the operation bed, she panicked and resisted because of labor pain and dyspnea. Therefore, anesthesia was induced instead of the initial plan. Finally, we successfully managed the anesthesia and delivered the newborn. There are no alternatives to general anesthesia in patients with PPCM presenting with orthopnea. Anesthesia induction in the supine position is impossible in such patients owing to dyspnea. Anesthesia should be started with light sedation in the sitting position, and ketamine or low-dose remifentanil may be an option to maintain maternal hemodynamics and prevent neonatal asphyxia.

Double Whammy Cases of Severe Mitral Stenosis in Peripartum: A Survival Case Series

“…Therefore, midazolam and fentanyl are commonly preferred in patients with cardiac dysfunction because of the relatively slow onset of the anesthetic effect and low effect on hemodynamics, respectively. 13 Here are some pros and cons of using general anesthesia in pregnancy. The pros of using general anesthesia in pregnancy include ensuring control and stability (the patient remains completely unaware and immobile during the procedure), effective pain management, and maintain stable maternal vital signs during the procedure.…”

Anestesi Epidural pada Pasien dengan Sindrom Eisenmenger yang Menjalani Seksio Sesarea

“…Oksigen tambahan untuk operasi seksio sesarea elektif dan darurat masih kontroversial untuk pasien sehat. 9 Pada pasien dengan sindrom Eisenmenger, oksigen merupakan vasodilator paru yang menurunkan aliran darah melewati shunt kanan-ke-kiri dan dengan demikian meningkatkan saturasi oksigen, sehingga harus dipertimbangkan untuk pasien dengan Sindrom Eisenmenger selama periode perioperatif. 9 Selain itu selang epidural dapat dipertahankan hingga periode pascaoperasi selesai sebagai akses untuk agen lokal anestesi untuk manajemen nyeri pascaoperasi.…”

“…9 Pada pasien dengan sindrom Eisenmenger, oksigen merupakan vasodilator paru yang menurunkan aliran darah melewati shunt kanan-ke-kiri dan dengan demikian meningkatkan saturasi oksigen, sehingga harus dipertimbangkan untuk pasien dengan Sindrom Eisenmenger selama periode perioperatif. 9 Selain itu selang epidural dapat dipertahankan hingga periode pascaoperasi selesai sebagai akses untuk agen lokal anestesi untuk manajemen nyeri pascaoperasi. Pada pasien ini saat dilakukan penilaian skala nyeri secara aktif didapatkan NRS 1-2 yang menggambarkan analgesia berlangsung cukup baik, sehingga dapat mengurangi perburukan shunt dari jantung kanan ke kiri.…”