Key result
Nebulised alprostadil administered post-delivery following titrated epidural anaesthesia safely reduced systolic pulmonary artery pressures in two pregnant women with Eisenmenger's syndrome.
Why the study?
Does slowly titrated epidural anaesthesia combined with nebulised alprostadil provide safe anaesthetic management for Caesarean section in pregnant women with Eisenmenger's syndrome?
Case Report (n=2)
No
Does slowly titrated epidural anaesthesia combined with nebulised alprostadil provide safe anaesthetic management for Caesarean section in pregnant women with Eisenmenger's syndrome?
Slowly titrated epidural anaesthesia and nebulised alprostadil may be a safe, accessible, and relatively cheap management strategy for Caesarean section in pregnant patients with Eisenmenger's syndrome.
May guide individualized peripartum care in Eisenmenger syndrome; leaves open need for prospective validation before practice change.
Pregnancy in patients with Eisenmenger’s syndrome is associated with a high mortality. This article reports two cases of women with Eisenmenger’s syndrome (secondary to two different primary cardiac defects) who presented with near-term pregnancies. Both the patients underwent successful elective Caesarean section with slowly titrated epidural anaesthesia. Nebulised prostaglandin E1(PGE1) analogue, alprostadil, administered immediately post-delivery resulted in a significant drop in systolic pulmonary artery pressures as measured from tricuspid regurgitant jet by transthoracic echocardiography. The postoperative period was uneventful in both patients. A slow induction of epidural anaesthesia can be a safe mode of anaesthesia for Caesarean section in pregnant patients with Eisenmenger’s syndrome. Nebulised alprostadil intraoperatively or postoperatively in the intensive care unit (ICU) is readily available and a relatively cheap option as a selective pulmonary vasodilator in developing countries.
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Dasgupta et al. (2016) conducted a case report in Eisenmenger's syndrome in pregnancy (n=2). Titrated epidural anaesthesia and nebulised alprostadil was evaluated on Systolic pulmonary artery pressure (PASP). Nebulised alprostadil administered post-delivery following titrated epidural anaesthesia safely reduced systolic pulmonary artery pressures in two pregnant women with Eisenmenger's syndrome.
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