Epidural Anesthesia in Management of Pregnant Eissenmenger’s Syndrome Patient Undergoing Caesarean Section

I. G. N. B. Jayantha Ananda, Tjahya Aryasa, Tjokorda Gde Agung Senapathi
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Abstract

Background: Eisenmenger syndrome is very rare in pregnant women. Debates remain concerning the management of Eisenmenger syndrome in this patient population, and the prognosis is unclear in terms of maternal and fetoneonatal outcomes. Managing anesthesia in maternal patients with a cardiac abnormality might be particularly difficult because these individuals have inadequate circulatory reserves and altered maternal cardiovascular physiology. Case presentation: We present a 26-year-old 34 weeks pregnant woman with Eisenmenger’s syndrome (ES) scheduled for an elective caesarean section. The clinical findings reveal slight tachypnea with peripheral oxygen saturation of 82% with oxygen supplementation using a cannula at 3 lpm. The patient's baseline hemodynamics are stable, but a third-degree murmur is heard in the 3rd and 4th left intercostal space. The patient was managed with epidural anesthesia using bupivacaine 0.5% 20 ml without adjuvant. The epidural catheter was inserted in an interspinous process between L3-L4. The surgery was done in 90 minutes with stable hemodynamics, and postoperatively, the patient was monitored in the intensive cardiac care unit (ICCU). Conclusion: Epidural anesthesia has been shown to provide favorable outcomes due to its slow onset and reducing the likelihood of abrupt hemodynamic changes.
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硬膜外麻醉在管理接受剖腹产手术的艾森曼格综合征孕妇中的应用
背景介绍艾森曼格综合征在孕妇中非常罕见。关于如何处理艾森曼格综合征患者,目前仍存在争议,而且就孕产妇和胎儿-新生儿的预后而言也不明确。对心脏异常的孕产妇进行麻醉可能尤其困难,因为这些患者的循环储备不足,而且母体的心血管生理结构也发生了改变。病例介绍:我们为您介绍一位 26 岁、怀孕 34 周、患有艾森曼格综合征(ES)的孕妇,她计划进行择期剖腹产手术。临床表现为轻微呼吸困难,外周血氧饱和度为 82%,使用插管以每分钟 3 升的速度补充氧气。患者的基线血流动力学稳定,但在左肋间隙第 3 和第 4 肋间听到三级杂音。医生使用 0.5% 布比卡因 20 毫升(不含辅助剂)对患者进行硬膜外麻醉。硬膜外导管插入 L3-L4 之间的棘突间。手术在 90 分钟内完成,血流动力学稳定,术后患者在心脏重症监护室(ICCU)接受监护。结论硬膜外麻醉起效缓慢,减少了血流动力学突然变化的可能性,因此已被证明能提供良好的治疗效果。
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