Spinal anesthesia with low-dose bupivacaine and fentanyl may be a safe and effective alternative to general anesthesia for emergency cesarean section in selected parturients with uncorrected tetralogy of Fallot.
May support spinal anesthesia feasibility in selected uncorrected tetralogy of Fallot cases; leaves open prospective validation before practice change.
A subarachnoid block is an effective way of providing anesthesia for cesarean sections. However, it can be considered relatively contra-indicated in parturients with uncorrected tetralogy of Fallot (TOF). We report a case of a 22-year-old female patient with TOF and gestational hypertension, who presented for an emergency cesarean section for placental abruption. The surgery was successfully conducted under a spinal anesthetic with a combination of low dose bupivacaine and fentanyl. Fentanyl combined with small-dose bupivacaine in the subarachnoid space can be considered as an alternative technique to general anesthesia, in selected parturients with uncorrected TOF presenting for cesarean section, especially in cases where the risks of administering a general anesthetic are deemed high.
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Parida et al. (2014) studied this question.
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