Open AccessEpidural anesthesia: A safe option for cesarean section in parturient with severe pulmonary hypertension
Author(s) -
Sreyashi Sen,
Sourav Chatterjee,
Pinaki Mazumder,
Sudakshina Mukherji
Publication year - 2016
Publication title -
journal of natural science, biology and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.236
H-Index - 30
eISSN - 2229-7707
pISSN - 0976-9668
DOI - 10.4103/0976-9668.184708
Subject(s) - medicine , anesthesia , heart disease , exacerbation , valvular heart disease , pregnancy , vascular resistance , pulmonary hypertension , perioperative , intubation , hemodynamics , cardiology , genetics , biology
Rheumatic heart disease is the most common cardiac disease complicating pregnancy in developing countries. Heart disease accounts for 15% pregnancy-related mortality. In the presence of maternal heart disease, the circulatory changes of pregnancy may result in exacerbation of the hemodynamic perturbations due to complex cardiac valvular lesions leading to decompensation or death of mother or fetus. Determining the ideal anesthetic technique for cesarean section in the presence of complex cardiac conditions remains a much debated topic. General anesthesia is associated with a further increase in pulmonary pressure in response to laryngoscopy and intubation along with myocardial depression by anesthetic agents. Neuraxial blockade may lead to decrease in systemic vascular resistance and cardiac output. We report the successful anesthetic management of a parturient suffering from rheumatic heart disease with multivalvular lesions resulting in severe pulmonary hypertension under epidural anesthesia with good maternal and neonatal outcome. Successful management requires vigilant perioperative monitoring and thorough knowledge of the hemodynamics of complex cardiac valvular disease.