Low Dose Thoracic Segmental Spinal Anaesthesia With Isobaric Levobupivacaine: Is It an Option for Patient With Severe Heart Disease Undergoing Emergency Cesarean Section? A Case Study.

Background: Heart disease is the third most common cause of maternal death. In the anaesthesia protocol for cesarean sections in pregnant individuals with heart disease, especially those facing severe mitral stenosis, general anaesthesia and/or epidural anaesthesia are generally preferred choices, but there is one article which emphasises potential benets of low dose subarachnoid block in certain cases. The primary aim of an anaesthesiologist is to prevent intraoperative hemodynamic instability. Thoracic segmental spinal anaesthesia stands out as an additional method offering remarkable hemodynamic stability and fostering elevated patient satisfaction levels . LSCS can be effectively and safely conducted through the procient application of segmental thoracic spinal anaesthesia. This case study aims to observe the outcome of my patient with heart disease undergoing emergency LSCS under low dose thoracic segmental spinal anaesthesia with isobaric levobupivacaine. Case Study: 24-year-old, G2P1L1, previous 1 cesarean scar, DCDA twins, with rheumatic origin severe mitral stenosis complicated with severe pulmonary artery hypertension and severe tricuspid regurgitation with severe pre-eclampsia, posted for an emergency LSCS under ASA IV(E). Thoracic segmental spinal anaesthesia was administered at T10-T11 space using a 25G Quincke's needle. This procedure utilized a 1.3 ml injection of 0.25% isobaric levobupivacaine, with the addition of 30 micrograms of buprenorphine. Post-operative pain relief was achieved through a transverse abdominis plane block using a 0.25% bupivacaine injection 40ml and 8mg dexamethasone injection provided bilaterally. The patient's intraoperative occurrences, hemodynamic stability, post-operative ICU care, and pain management were all carefully observed and noted. Result: The procedure went smoothly without any complications, exhibiting notable hemodynamic stability and effective post-operative pain relief for a duration of 18 hours. In resource-limited peripheral centers lacking dedicated postoperative cardia Conclusion: c intensive care, low- dose thoracic segmental spinal anaesthesia emerges as a viable alternative for emergency cesarean sections in patients with severe heart disease experiencing fetal distress.