Initial non-opioid based anesthesia in a parturient having severe aortic stenosis undergoing cesarean section with aortic valve replacement

• Published in: Annals of cardiac anaesthesia 2015-01, Vol.18 (1), p.98-100
• Main Authors: Podder, Subrata, Kumar, Ajay, Mahajan, Sachin, Saha, Pradip
• Format: Article
• Language: English
• Subjects: Abdomen; Acute kidney injury; Airway; dexmedetomidine; radiographic assessment; Anesthesia; Aortic stenosis; Aortic valve replacement; Cesarean section; Pregnancy; Anti-platelet therapy; Bleeding; Coronary artery bypass grafting; Multiplate; Platelet Dysfunction; Platelet function assessment; Aortic dissection flap; Aortic valve stenosis; Aprotinin; Bleeding; Cardiopulmonary bypass; Paediatric open-heart surgery; Tranexamic acid; Atrial fibrillation; Cardiac surgery; Diastolic dysfunction; Diastolic function; Postoperative; Atrial septal defects; Blood pressure; Cardiac resynchronization therapy; coronary artery bypass; heart failure; Cardiac surgery; Cardiac surgery; Davinci; One-lung ventilation; Totally endoscopic coronary artery bypass; Transesophageal echocardiography; Robotic surgery; Minimally invasive cardiac surgery; Cardiology; Care and treatment; Case Report; Case studies; Cesarean section; Clinical research; Congenital heart disease; Coronary artery bypass graft; hypoxemia; patent foramen ovale; stroke; Developing country; outcomes; quality improvement; Diagnosis; Echocardiography; Fetuses; Health aspects; Heart failure; Heart rate; intra-operative echocardiography; Left ventricle; Myxoma; Thrombus; Left ventricular rupture; measurement types; mitral valve replacement; Mortality; Narcotics; Neutrophil gelatinase-associated lipocalin; Opioids; Patient outcomes; Patients; Postoperative pain; predictive modelling; Pregnancy; Premature labor; presternal bupivacaine infusion; Pulmonary arteries; Respiratory distress syndrome; Risk factors; statistical analysis; sternotomy; Three- dimensional echocardiography; three-dimensional transesophageal echocardiography; Transesophageal echocardiography; Transthoracic echocardiography; Two-dimensional echocardiography; type A aortic dissection; Ventilation
• ISSN: 0971-9784; 0974-5181
• DOI: 10.4103/0971-9784.148330

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.