Key result
Combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring successfully maintained maternal systolic blood pressure at ≥90% of baseline without requiring rescue cardiovascular agents.
Why the study?
Transplacental treatment of fetal tachyarrhythmia can worsen maternal hypotension and bradycardia, while intraoperative rescue cardiovascular agents can exacerbate fetal tachycardia, but reports on anesthetic management are rare.
Case Report (n=1)
Combined spinal-epidural anesthesia with non-invasive continuous hemodynamic monitoring can be safely used for cesarean section in patients receiving transplacental treatment for fetal tachyarrhythmia with digoxin and sotalol.
Suggests feasibility of this anesthetic approach during cesarean delivery for mothers on transplacental antiarr.
BACKGROUND: Although rare, long-lasting fetal tachyarrhythmia often leads to fetal heart failure and hydrops. Some mothers receive transplacental treatment of fetal tachyarrhythmia (TTFT), which can potentially worsen maternal hypotension and bradycardia. Moreover, the use of rescue cardiovascular agents intraoperatively can worsen fetal tachycardia. However, reports of the anesthetic management of patients receiving TTFT are rare. CASE PRESENTATION: A 31-year-old woman who was receiving digoxin and sotalol for TTFT underwent planned elective cesarean section. The fetus had hypoplastic left heart syndrome, hydrops, and tachycardia. We used combined spinal-epidural anesthesia with a reduced dose of local anesthetic. We also employed a non-invasive continuous hemodynamic monitoring system. The mother's systolic blood pressure remained at ≥ 90% of the baseline value; intraoperative administration of rescue cardiovascular agents was not required. CONCLUSIONS: We successfully anesthetized a woman for cesarean section, who was receiving TTFT for fetal tachyarrhythmia, using combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring.
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Tanaka et al. (2019) conducted a case report in Fetal tachyarrhythmia (n=1). Combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring was evaluated on Maternal systolic blood pressure maintenance and need for rescue cardiovascular agents. Combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring successfully maintained maternal systolic blood pressure at ≥90% of baseline without requiring rescue cardiovascular agents.
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