Anesthetic considerations for cesarean section in a parturient complicated by Scimitar syndrome-like pathophysiology

BACKGROUND: Pre-existing poor respiratory function is a significant challenge for women to successfully continue pregnancy and accomplish delivery. CASE: Pregnancy and delivery were successfully managed without any maternal or neonatal complications, in a 26-year-old woman with severely impaired respiratory function, due to a unilateral hypoplastic lung, accompanying Scimitar syndrome-like circulation. Hyperventilation, normally observed even at the first trimester, was absent by the end of the second trimester. This would indicate her ventilation must have reached utmost capacity. Premature delivery by the mode of elective cesarean section delivery was, therefore, the most reasonable option. General anesthesia, combined with a continuous epidural infusion of low-concentrate local anesthetics, containing opioid, was sufficient to avoid the need for unexpected mechanical ventilation in intra- and early postoperative periods and to provide excellent post-partum analgesia. CONCLUSION: This combination can be a potent alternative in tailoring anesthesia for cesarean section in women with extremely impaired pulmonary reserve.