Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report

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.