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Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report
Authors:Corbett W L  Reiter C M  Schultz J R  Kanter R J  Habib A S
Affiliation:1 Department of Anaesthesiology, Box 3094, Duke University Medical Center Durham, NC 27710, USA
2 Department of Paediatric Cardiology, Duke University Medical Center Durham, NC 27710, USA
Abstract:Postural orthostatic tachycardia syndrome encompasses a groupof disorders characterized by orthostatic intolerance. We describethe anaesthetic management of analgesia for labour and of Caesareansection in a parturient suffering from this disorder. Worseningof her symptoms during pregnancy was managed with an increasein the dose of ß-blockers taken by the patient. Epiduralanalgesia was instigated early to attenuate the stress of labourand avoid consequent triggering of a tachycardic response. Slowtitration of epidural analgesia and anaesthesia after an adequatefluid preload was undertaken to minimize hypotension and subsequenttachycardia. Neuraxial opioid, combined with non-steroidal anti-inflammatorydrugs and bilateral iliohypogastric and ilioinguinal nerve blockswere used to optimize postoperative analgesia.
Keywords:anaesthesia, obstetric, Caesarean section   anaesthetic techniques, epidural   complications, labour   complications, postural orthostatic tachycardia syndrome
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