Anesthetic Management of Caesarean Section in a Patient with Double Outlet Right Ventricle

Krishna, Rohith and Goneppanavar, Umesh (2012) Anesthetic Management of Caesarean Section in a Patient with Double Outlet Right Ventricle. Journal of Obstetric Anaesthesia and Critical Care , 2 (1). pp. 50-52.

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Double outlet right ventricle (DORV) is a rare congenital heart defect involving the great arteries. In DORV, both aorta and pulmonary artery arise from the right ventricle resulting in admixture of blood. We report a 22-year-old parturient with DORV and severe pulmonary stenosis who underwent caesarean delivery at 36 weeks gestation with low dose combined spinal-epidural anesthesia. This lady was assessed by echocardiogram to have situs inversus, dextrocardia, severe pulmonary artery stenosis (gradient = 146 mm Hg), DORV with subarterial VSD (1 cm). She had 95% room air saturation and her blood investigations were within normal limits. We established a peripheral venous access and radial arterial line for continuous blood pressure monitoring. Combined spinal epidural anesthesia was considered a better option. Epidural catheter was secured at L2-L3 space and fixed after giving test dose 3 mL 2% lignocaine. Subarachnoid block administered at L3-L4 level using 1.2 mL of 0.5% heavy bupivacaine. A sensory block of T10 was obtained which was supplemented with 4 mL 0.75% ropivacaine to obtain a level of T6. Patient tolerated the procedure well. She was shifted to post-operative ICU. Post-operative pain was managed with epidural 0.2% ropivacaine at 4 mL/h. Patient remained hemodynamically stable throughout the procedure and in the postoperative period while she was being followed up for subsequent 48 h.

Item Type: Article
Uncontrolled Keywords: Caesarean section, combined spinal epidural anesthesia, double outlet right ventricle
Subjects: Medicine > KMC Manipal > Anaesthesiology
Depositing User: KMC Manipal
Date Deposited: 26 Oct 2013 07:26
Last Modified: 26 Oct 2013 07:26

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