Journal of Health and Medical Sciences
ISSN 2622-7258
Published: 24 October 2022
Anesthesia Management of Sectio Caesarian Patients with Eisenmenger Syndrome and Fetal Distress
Indriasari, Iwan Fuadi, Reza W. Sudjud, Irvan
University of Padjadjaran
Download Full-Text Pdf
10.31014/aior.1994.05.04.243
Pages: 31-37
Keywords: Congenital Heart Disease, Cesarean Section, Eisenmenger Syndrome, General Anesthesia, Pregnant Women
Abstract
Brief overview: 27 year old woman, G2P1A0 gravida 35-36 weeks with congenital heart disease (ventricular septal defect) that progresses to Eisenmenger syndrome, respiratory failure and fetal distress underwent an emergency caesarean section. Management: Anesthesia management was performed under general anesthesia with post-operative care in ICU. Prior to induction, pre-oxygenated with 100% O2 was performed, followed by Rapid Sequence Induction with Ketamine 70 mg, and Rocuronium 50 mg. After the patient had fallen asleep the Sellick maneuver was performed, intubated with ETT no. 6.5. Anesthesia maintenance with Sevoflurane 1 vol%, and 100% oxygen. Fentanyl 50 μg was given after the baby was born. Outcome: In this patient, general anesthetic technique was preferred over regional anesthetic technique for better maternal and fetal outcomes because this patient had already experienced respiratory failure and fetal distress, so a caesarean section was decided as soon as possible. The operation lasted for two hours, with SpO2 during the operation reaching 85% and a live baby boy was born with APGAR scores at the 1st ,3rd and 5th minute 6. Postoperatively, the patient remained intubated and was transferred to the intensive care unit with vital signs blood pressure 122/80 mmHg, pulse 96 beats per minute, SpO2 82-85%.
References
Arendt, K. W., & Lindley, K. J. (2019). Obstetric anesthesia management of the patient with cardiac disease. International Journal of Obstetric Anesthesia, 37, 73–85. https://doi.org/10.1016/j.ijoa.2018.09.011
Arendt, K. W., Muehlschlegel, J. D., & Tsen, L. C. (2012). Cardiovascular alterations in the parturient undergoing cesarean delivery with neuraxial anesthesia. Expert Review of Obstetrics & Gynecology, 7(1), 59–75. https://doi.org/10.1586/eog.11.79
Arif, S. K., Wahab, A., & Tofani, R. M. (2017). Manajemen Anestesia pada Kehamilan dengan Sindrom Eisenmenger. JAI (Jurnal Anestesiologi Indonesia), 9(1), 19. https://doi.org/10.14710/jai.v9i1.19821
Canobbio, M. M., Warnes, C. A., Aboulhosn, J., Connolly, H. M., Khanna, A., Koos, B. J., Mital, S., Rose, C., Silversides, C., & Stout, K. (2017). Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation, 135(8). https://doi.org/10.1161/CIR.0000000000000458
Cole, P. J., Cross, M. H., & Dresner, M. (2001). Incremental spinal anaesthesia for elective Caesarean section in a patient with Eisenmenger’s syndrome. British Journal of Anaesthesia, 86(5), 723–726. https://doi.org/10.1093/bja/86.5.723
Dasgupta, S., Das, S., Majumdar, B., & Basu, S. (2016). Caesarean section in Eisenmenger’s syndrome: anaesthetic management with titrated epidural and nebulised alprostadil. Southern African Journal of Anaesthesia and Analgesia, 22(2), 65–67. https://doi.org/10.1080/22201181.2016.1145432
Duan, R., Xu, X., Wang, X., Yu, H., You, Y., Liu, X., Xing, A., Zhou, R., & Xi, M. (2016). Pregnancy outcome in women with Eisenmenger’s syndrome: a case series from west China. BMC Pregnancy and Childbirth, 16(1), 356. https://doi.org/10.1186/s12884-016-1153-z
Fawcett, W. J. (2019). Suxamethonium or rocuronium for rapid sequence induction of anaesthesia? BJA Education, 19(12), 380–382. https://doi.org/10.1016/j.bjae.2019.09.001
Gehlot, R. Kr., Verma, D., & Raiger, L. K. (2021). A challenging case of a successful outcome of cesarean section with combined spinal–epidural technique in a parturient with Eisenmenger syndrome. Ain-Shams Journal of Anesthesiology, 13(1), 6. https://doi.org/10.1186/s42077-021-00127-9
Gurumurthy, T., Hegde, R., & Mohandas, B. (2012). Anaesthesia for a patient with Eisenmenger′s syndrome undergoing caesarean section. Indian Journal of Anaesthesia, 56(3), 291. https://doi.org/10.4103/0019-5049.98780
Lopez, B. M., Malhamé, I., Davies, L. K., Gonzalez Velez, J. M., Marelli, A., & Rabai, F. (2020). Eisenmenger Syndrome in Pregnancy: A Management Conundrum. Journal of Cardiothoracic and Vascular Anesthesia, 34(10), 2813–2822. https://doi.org/10.1053/j.jvca.2020.02.053
Popat, M., & Russell, R. (2001). CORRESPONDENCE. International Journal of Obstetric Anesthesia, 10(4), 332–333. https://doi.org/10.1054/ijoa.2001.0889
Rao, S., & Ginns, J. N. (2014). Adult congenital heart disease and pregnancy. Seminars in Perinatology, 38(5), 260–272. https://doi.org/10.1053/j.semperi.2014.04.015
Soefviana, S., & Zulfariansyah, A. (2021). Anesthesic Management in Pregnant Woman with Eisenmenger Syndrome. Jurnal Anestesi Obstetri Indonesia, 4(1), 26–34. https://doi.org/10.47507/obstetri.v4i1.51
Lee, S. Y. , Ko, J. S. , Jung, J. W. , Lee, S. M. , Kang, I. S. , & Park, S. W. , et al. (2007). Perioperative management of a parturient with eisenmenger's syndrome undergoing cesarean section :a case report.
Yen, P. (2015). ASD and VSD Flow Dynamics and Anesthetic Management. Anesthesia Progress, 62(3), 125–130. https://doi.org/10.2344/0003-3006-62.3.125
Yentis, S. M., Steer, P. J., & Plaat, F. (1998). Eisenmenger’s syndrome in pregnancy: maternal and fetal mortality in the 1990s. BJOG: An International Journal of Obstetrics and Gynaecology, 105(8), 921–922. https://doi.org/10.1111/j.1471-0528.1998.tb10240.x
Yuan, S.-M. (2016). Eisenmenger Syndrome in Pregnancy. Brazilian Journal of Cardiovascular Surgery. https://doi.org/10.5935/1678-9741.20160062