Continuous spinal anesthesia for cesarean section in a parturient with severe recurrent peripartum cardiomyopathy

The anesthetic management of labor and delivery in patients with peripartum cardiomyopathy is not well defined. Using continuous spinal anesthesia in such a rare clinical situation has not been previously reported. A patient with recurrent peripartum cardiomyopathy presented in congestive heart failure for emergent cesarean section. Continuous spinal anesthesia was successfully employed as the anesthetic technique for the procedure. In addition, it also markedly reduced the patient's symptoms. Continuous spinal anesthesia is a reliable, rapidly titratable technique, which provides excellent analgesia with minimal undesirable hemodynamic changes for patients with peripartum cardiomyopathy undergoing cesarean delivery.     

Successful vaginal delivery for a parturient with complete aortic coarctation

This report describes the case of a parturient with complete coarctation of the aorta that was diagnosed during pregnancy. The use of invasive monitoring and the choice of labor analgesia for vaginal delivery are reviewed. Management of patients with complex cardiac anomalies requires consultation among cardiologist, obstetricians, and anesthesiologists to ensure good outcome for the mother and baby.     

General anesthesia with remifentanil for Cesarean section in a parturient with an acoustic neuroma

PURPOSE: To describe the anesthetic management of a parturient with a large acoustic neuroma undergoing general anesthesia with remifentanil for Cesarean section. CLINICAL FEATURES: A near-term parturient presented with a large intracranial mass. Cesarean section under general anesthesia was elected one week prior to craniotomy for tumour resection. Remifentanil infusion, 0.2-1.0 microg x kg(-1) x min(-1), was used from induction to emergence of general anesthesia. The neonate was born seven minutes after the remifentanil infusion was started. She had normal umbilical cord pH and her Apgar scores were 7 and 8, at one and five minutes respectively. Although the neonate received supplemental oxygen, she did not require naloxone. Both mother and neonate made an uneventful recovery. CONCLUSION: Remifentanil was effective in producing stable hemodynamic conditions, without severe neonatal respiratory depression, during induction and maintenance of general anesthesia for a Cesarean delivery in a parturient with a large intracranial tumour.     

Anaesthetic management for caesarean section in a parturient with uncorrected coarctation of the aorta

We present the case of a woman who refused RMI examination to diagnose a coarctation of her aorta before her third pregnancy. At term of 34 weeks of gestation the caesarean delivery was scheduled under spinal-epidural anaesthesia. Despite the use of a titrated regional anaesthesia, an important arterial hypotension occurred, restored with low doses of vasopressive agents.     

Anesthesia for cesarean section in a parturient taking risperidone and haloperidol

We report a case of anesthesia for cesarean section in a schizophrenic patient. Her psychiatric symptoms were well controlled with low doses of risperidone until 35 weeks' gestation, when she suddenly developed psychotic manifestations. Risperidone 6 mg x day(-1) and haloperidol 12 mg x day(-1) PO were given for 3 weeks before delivery. Elective cesarean section was performed under spinal anesthesia at 38 weeks. The parturient showed good psychiatric condition during and after the surgery. The neonate did not show any symptoms which antipsychotics could have caused. Maternal and umbilical blood concentrations of risperidone and haloperidol are reported.     

Anesthetic considerations for cesarean section in the parturient with familial cardiomyopathy

Dilated cardiomyopathy (DCM) is a heart muscle disease characterized by ventricular dilatation and impaired systolic cardiac function. DCM is defined by the presence of: a) fractional myocardial shortening less then 25% (> 2 SD) and/or ejection fraction less than 45% (> 2 SD); and b) left ventricular end diastolic diameter (LVEDD) greater than 117% excluding any known cause of myocardial disease. Familial dilated cardiomyopathy (FDC) accounts for 20-48% of all DCM cases, and is defined by the presence of two or more affected relatives with DCM meeting the above diagnostic criteria or a relative of a DCM patient with unexplained sudden death before the age of 35 years. We herein present the first reported case in the literature of a parturient with FDC undergoing urgent Cesarean section (secondary to worsening cardiac function) and briefly highlight anesthetic considerations for parturients with this heart condition.     

Perioperative anesthetic management for cesarean section of a parturient with gestational diabetes insipidus

PURPOSE: Gestational diabetes insipidus (GDI) is a rare endocrinopathy complicating about 4:100,000 deliveries. We present the case of a preterm parturient with GDI and severe hypernatremia (serum sodium concentration = 174 mmol.L(-1)) presenting for an urgent Cesarean section. CLINICAL FEATURES: Fluid resuscitation and desmopressin supplementation partially corrected the patient's homeostasis, allowing us to carefully titrate epidural anesthesia for an urgent Cesarean section. After delivery, the patient was transferred to the intensive care unit. The serum sodium concentration of the mother and the neonate was normalized over 48 hr and three days respectively. CONCLUSION: The careful perioperative management of GDI led to a favourable outcome of the mother and fetus.     

Epidural anesthesia in a parturient with neurofibromatosis type 2 undergoing cesarean section

Neurofibromatosis type 2 (NF2) is a rare condition only recently recognized. We present a case describing successful regional analgesia in a parturient with NF2 after thorough imaging revealed no tumors within the epidural space. The presence of tumors within the spinal cord and nerve roots and their potential enlargement during pregnancy make routine neuraxial anesthesia hazardous in patients with NF2. Lumbosacral imaging before performing regional anesthesia is recommended.     

Successful epidural anesthesia for cesarean section in a parturient with severe aortic stenosis and a recent history of pulmonary edema--a case report

We report a 24-year-old 36-week gestation parturient with severe aortic stenosis who developed pulmonary edema during amniocentesis and subsequently underwent a successful cesarean section under epidural anesthesia. Anesthetic management and some pertinent points are discussed.     

Epidural anesthesia for cesarean section in a parturient with pseudotumor cerebri and lumboperitoneal shunt

We present a case of successful epidural analgesia/anesthesia for labor and cesarean section in a parturient who developed pseudotumor cerebri during her pregnancy and was managed with lumboperitoneal shunt secondary to her visual complication.     

Combined spinal and epidural anesthesia for cesarean section in a parturient with moyamoya disease

We present the case of a parturient with moyamoya disease admitted to the hospital for elective cesarean section. Combined spinal and epidural technique was chosen because it allows better analgesia than epidural anesthesia and more hemodynamic stability than either general or spinal anesthesia. Ropivacaine was the local anesthetic of choice for the epidural portion because of the wide sensory-motor dissociation, thus preserving adequate respiration in the case of a high block.     

Regional anaesthesia with a subarachnoid microcatheter for Caesarean section in a parturient with aortic stenosis

We present a woman in her first pregnancy, with known aortic stenosis prior to conception, who successfully underwent regional anaesthesia for an elective Caesarean section using a subarachnoid microcatheter. The anaesthetic management of patients with aortic stenosis requiring noncardiac surgery is a complex and contentious matter, particularly when the situation is compounded by the physiological changes accompanying pregnancy and delivery. This is the first reported use of a subarachnoid microcatheter in such a patient. The choice of technique is discussed and compared with other options for providing anaesthesia.