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Epidural anesthesia for emergency cesarean section in a woman with Fontan circulation: A case report

RATIONALE: Anesthetic management of pregnant women with Fontan circulation remains challenging. There are few reports that describe the anesthetic management of cesarean section after Fontan surgery. Here, we present a case of successful epidural anesthesia in a woman with Fontan circulation who req...

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Autores principales: Wu, Pin, Zhu, Sheng-Mei, Yao, Yong-Xing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004742/
https://www.ncbi.nlm.nih.gov/pubmed/31977915
http://dx.doi.org/10.1097/MD.0000000000018986
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author Wu, Pin
Zhu, Sheng-Mei
Yao, Yong-Xing
author_facet Wu, Pin
Zhu, Sheng-Mei
Yao, Yong-Xing
author_sort Wu, Pin
collection PubMed
description RATIONALE: Anesthetic management of pregnant women with Fontan circulation remains challenging. There are few reports that describe the anesthetic management of cesarean section after Fontan surgery. Here, we present a case of successful epidural anesthesia in a woman with Fontan circulation who required emergency cesarean section. PATIENT CONCERNS: A 29-year-old woman at gestational week 28 was scheduled for emergency cesarean section because of fetal distress. Her past medical history was significant for congenital transposition of the great arteries that had been treated by Fontan surgery 26 years earlier. Her postoperative course had been uneventful and she had reached a near normal level of activity with no arrhythmias or thrombotic complications. On presentation, her oxygen saturation was approximately 84% and she had digital clubbing. Arterial blood gas analysis showed a PCO(2) of 35 mmHg, PO(2) of 55.5 mmHg, and hemoglobin of 16.3 g/dL. Her blood coagulation parameters were within normal limits except for a high fibrinogen concentration (4.55 g/L). DIAGNOSIS: The diagnosis was pregnancy requiring emergency cesarean section because of fetal distress. INTERVENTIONS: Before anesthesia, a radial artery line was established for continuous measurement of blood pressure. An air pressure pump was placed on the patient's lower limbs and a low-dose dobutamine infusion was started. Next, epidural anesthesia was successfully performed at L2–3. Five milliliters of 2% lidocaine followed by 10 mL of 0.75% ropivacaine were injected. Dobutamine was infused to maintain a target blood pressure of 100–120/60–70 mmHg. OUTCOMES: The procedure was uneventful with the patient maintaining a stable heart rate of 80 to 90 beats/min and an oxygen saturation of 90% to 94%. A male infant weighing 840 g was delivered. The Apgar score was 9 at 1 and 5 minutes. The patient was transferred to the intensive care unit for 20 hours of monitoring and discharged 9 days later. The neonate was discharged after 2 months of specialist neonatal treatment. LESSONS: Epidural anesthesia may be used in women with Fontan circulation undergoing emergency cesarean section. Knowledge of the physiology of the heart lesion and that of pregnancy are critical to the outcome.
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spelling pubmed-70047422020-02-18 Epidural anesthesia for emergency cesarean section in a woman with Fontan circulation: A case report Wu, Pin Zhu, Sheng-Mei Yao, Yong-Xing Medicine (Baltimore) 3300 RATIONALE: Anesthetic management of pregnant women with Fontan circulation remains challenging. There are few reports that describe the anesthetic management of cesarean section after Fontan surgery. Here, we present a case of successful epidural anesthesia in a woman with Fontan circulation who required emergency cesarean section. PATIENT CONCERNS: A 29-year-old woman at gestational week 28 was scheduled for emergency cesarean section because of fetal distress. Her past medical history was significant for congenital transposition of the great arteries that had been treated by Fontan surgery 26 years earlier. Her postoperative course had been uneventful and she had reached a near normal level of activity with no arrhythmias or thrombotic complications. On presentation, her oxygen saturation was approximately 84% and she had digital clubbing. Arterial blood gas analysis showed a PCO(2) of 35 mmHg, PO(2) of 55.5 mmHg, and hemoglobin of 16.3 g/dL. Her blood coagulation parameters were within normal limits except for a high fibrinogen concentration (4.55 g/L). DIAGNOSIS: The diagnosis was pregnancy requiring emergency cesarean section because of fetal distress. INTERVENTIONS: Before anesthesia, a radial artery line was established for continuous measurement of blood pressure. An air pressure pump was placed on the patient's lower limbs and a low-dose dobutamine infusion was started. Next, epidural anesthesia was successfully performed at L2–3. Five milliliters of 2% lidocaine followed by 10 mL of 0.75% ropivacaine were injected. Dobutamine was infused to maintain a target blood pressure of 100–120/60–70 mmHg. OUTCOMES: The procedure was uneventful with the patient maintaining a stable heart rate of 80 to 90 beats/min and an oxygen saturation of 90% to 94%. A male infant weighing 840 g was delivered. The Apgar score was 9 at 1 and 5 minutes. The patient was transferred to the intensive care unit for 20 hours of monitoring and discharged 9 days later. The neonate was discharged after 2 months of specialist neonatal treatment. LESSONS: Epidural anesthesia may be used in women with Fontan circulation undergoing emergency cesarean section. Knowledge of the physiology of the heart lesion and that of pregnancy are critical to the outcome. Wolters Kluwer Health 2020-01-24 /pmc/articles/PMC7004742/ /pubmed/31977915 http://dx.doi.org/10.1097/MD.0000000000018986 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 3300
Wu, Pin
Zhu, Sheng-Mei
Yao, Yong-Xing
Epidural anesthesia for emergency cesarean section in a woman with Fontan circulation: A case report
title Epidural anesthesia for emergency cesarean section in a woman with Fontan circulation: A case report
title_full Epidural anesthesia for emergency cesarean section in a woman with Fontan circulation: A case report
title_fullStr Epidural anesthesia for emergency cesarean section in a woman with Fontan circulation: A case report
title_full_unstemmed Epidural anesthesia for emergency cesarean section in a woman with Fontan circulation: A case report
title_short Epidural anesthesia for emergency cesarean section in a woman with Fontan circulation: A case report
title_sort epidural anesthesia for emergency cesarean section in a woman with fontan circulation: a case report
topic 3300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004742/
https://www.ncbi.nlm.nih.gov/pubmed/31977915
http://dx.doi.org/10.1097/MD.0000000000018986
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