Key result
Goal-directed fluid therapy and combined spinal-epidural anesthesia facilitate complication-free cesarean section in severe aortic stenosis.
Why the study?
Physiological changes during pregnancy can worsen aortic stenosis symptoms, presenting challenges in obstetric anesthetic management that require appropriate anesthetic, cardiac, and obstetric collaboration.
Does goal-directed fluid therapy and combined spinal-epidural anesthesia prevent complications in a pregnant woman with severe aortic stenosis undergoing cesarean section?
Case Report (n=1)
Does goal-directed fluid therapy and combined spinal-epidural anesthesia prevent complications in a pregnant woman with severe aortic stenosis undergoing cesarean section?
Low-dose sequential spinal anesthesia and slowly titrated epidural anesthesia under goal-directed fluid therapy guidance may be a safe approach for cesarean section in pregnant women with severe aortic stenosis.
Introduction: In parturients with heart disease, appropriate anesthetic, cardiac, and obstetric collaboration is necessary, especially in those with aortic stenosis (AS). Physiological changes during pregnancy can worsen AS symptoms, causing challenges in obstetric anesthetic management. Patient concerns and diagnosis: A 33-year-old woman with severe AS and progressive orthopnea, 33 weeks pregnant, required a cesarean section due to heart failure. Interventions: We used invasive goal-directed fluid therapy (GDFT) with real-time information on hemodynamic status and a more sophisticated approach to maintain intravascular volume balance. Combined spinal-epidural anesthesia was used under GDFT guidance. Outcomes: The patient underwent cesarean section under combined spinal-epidural with no complications, with a stable newborn status, and was discharged on postoperative day 4. Vasopressors or inotropes were not used during the operation. Conclusion: For cesarean section in severe AS, low-dose sequential spinal anesthesia and slowly titrated epidural anesthesia under GDFT guidance could be a safe way to manage challenging conditions.
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Lu et al. (2022) conducted a case report in Severe aortic stenosis in pregnancy (n=1). Goal-directed fluid therapy (GDFT) and combined spinal-epidural anesthesia was evaluated on Complications during cesarean section and newborn status. Goal-directed fluid therapy and combined spinal-epidural anesthesia allowed a 33-year-old pregnant woman with severe aortic stenosis to undergo a cesarean section with no complications.
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