Key result
Non-opioid anesthesia successfully manages combined cesarean delivery and AVR in severe AS yielding normal neonatal APGAR.
Why the study?
Does non-opioid based anesthesia prevent fetal morbidity in a parturient with severe aortic stenosis undergoing combined cesarean section and aortic valve replacement?
Case Report (n=1)
Does non-opioid based anesthesia prevent fetal morbidity in a parturient with severe aortic stenosis undergoing combined cesarean section and aortic valve replacement?
Non-opioid based anesthesia until delivery is a viable and safe strategy to prevent fetal respiratory depression during combined cesarean section and aortic valve replacement in parturients with severe aortic stenosis.
Supports non-opioid anesthesia feasibility in severe AS with combined CS-AVR; hypothesis-generating for fetal outcomes.
Pregnancy in presence of severe aortic stenosis (AS) causes worsening of symptoms needing further intervention. In the advanced stages of pregnancy, some patients may even require aortic valve replacement (AVR) and cesarean delivery in the same sitting. Opioid based general anesthesia for combined lower segment cesarean section (LSCS) with AVR has been described. However, the use of opioid may lead to fetal morbidity and need of respiratory support for the baby. We describe successful anesthetic management for LSCS with AVR in a >33 week gravida with severe AS and congestive heart failure. We avoided opioids till delivery of the baby AVR; the delivered neonate showed a normal APGAR score.
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Kumar et al. (2015) conducted a case report in Severe aortic stenosis and congestive heart failure in pregnancy (n=1). Non-opioid based anesthesia (avoiding opioids until delivery) was evaluated on Successful anesthetic management and neonatal APGAR score. Non-opioid based anesthesia until delivery was successfully used in a pregnant patient with severe aortic stenosis undergoing combined cesarean section and aortic valve replacement, resulting in a normal neonatal APGAR score.
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