Combined spinal fentanyl with graded epidural anaesthesia for caesarean section in case of peripartum cardiomyopathy: A case report

Perioperative management of peripartum cardiomyopathy patients posted for emergency caesarean section is a unique challenge to the anaesthesiologist. We are hereby reporting a case of peripartum cardiomyopathy posted for emergency caesarean section. A 23 year old lady with a 35 weeks pregnancy was admitted in our hospital with increasing breathlessness. Subsequently, she was diagnosed as a case of peripartum cardiomyopathy. She was posted for an urgent LUCS. After a rapid initial stabilization, she received combined spinal fentanyl with titrated epidural bupivacaine to achieve surgical anaesthesia. Apart from routine ASA monitors, CVP and IBP were monitored during the surgery. Hemodynamic perturbations were insignificant during surgery, and the postoperative period was uneventful. Key Messages: Combined spinal opioid with carefully titrated epidural anaesthesia is a safe and effective technique for anaesthetic management of peripartum cardiomyopathy posted for LUCS.