Key result
Continuous vasopressin infusion during combined spinal epidural anesthesia maintained intraoperative and postoperative hemodynamic stability in a pregnant patient with severe mitral stenosis.
Why the study?
Does continuous vasopressin infusion during combined spinal epidural anesthesia maintain hemodynamic stability in a pregnant patient with severe mitral stenosis and pulmonary hypertension undergoing cesarean section?
Case Report (n=1)
No
Does continuous vasopressin infusion during combined spinal epidural anesthesia maintain hemodynamic stability in a pregnant patient with severe mitral stenosis and pulmonary hypertension undergoing cesarean section?
Continuous vasopressin infusion during combined spinal epidural anesthesia successfully maintained hemodynamic stability in a pregnant patient with severe mitral stenosis and pulmonary hypertension undergoing emergency cesarean section.
Supports individualized anesthesia selection in severe MS with PH for emergency CS; leaves open optimal technique in this high-risk population.
Presence of mitral stenosis deteriorates the already compromised cardiac status of a pregnant female. Decision between regional and general anesthesia can be crucial in such cases. Our patient a 20-year-old, and primigravida scheduled for emergency cesarean section due to acute fetal distress was a diagnosed case of severe mitral stenosis and pulmonary hypertension (48 mmHg). During antenatal she was on anticoagulants and was monitored regularly. In the operation theater she was monitored for heart rate, invasive blood pressure, central venous pressure, SpO2 and urine output. We gave combined spinal epidural anesthesia (CSEA) at L3–4, using 7.5 mg 0.5% bupivacaine with 8% dextrose. Immediately after CSEA a continuous vasopressin infusion at 2–4 units/h was started, which took care of hypotension and pulmonary hypertension and it was stopped at the end of the surgery. The patient was stable hemodynamically intra and postoperatively. A baby of 2.2 kg was delivered with an APGAR score 7, 8, 9.
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Kannaujia et al. (2015) conducted a case report in Severe mitral stenosis with pulmonary hypertension in pregnancy (n=1). Combined spinal epidural anesthesia with continuous vasopressin infusion was evaluated on Hemodynamic stability. Continuous vasopressin infusion during combined spinal epidural anesthesia maintained intraoperative and postoperative hemodynamic stability in a pregnant patient with severe mitral stenosis.
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