1/17. Anaesthesia for caesarean section in the presence of severe primary pulmonary hypertension.We describe the case of a pregnant woman, 35 weeks' gestation, with primary pulmonary hypertension and coarctation of the aorta requiring emergency Caesarean section under general anaesthesia. The patient had a pulmonary artery catheter inserted before operation which revealed pulmonary artery pressures in excess of 80/40 mm Hg. These were lowered using an infusion of glyceryl trinitrate. After delivery of the baby and administration of oxytocin, pulmonary artery pressures were more difficult to control. An infusion of prostacyclin was substituted which stabilized pulmonary pressures. After operation, she was transferred to the intensive care unit where prostacyclin was administered by an "aerosolized" route. Her trachea was extubated after 48 h and she made an uneventful recovery.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/17. Primary pulmonary hypertension in pregnancy; a role for novel vasodilators.We describe the case of a 28-week pregnant woman presenting with severe primary pulmonary hypertension (PPH). She had an elective Caesarean section under general anaesthesia at 32 weeks gestation. pulmonary artery pressures (PAP) measured from a pulmonary artery catheter before anaesthesia were in excess of 100 mm Hg. Intraoperative nitric oxide was used to reduce PAP. After the delivery of a healthy infant PAP was controlled with nebulized iloprost and a prostacyclin infusion. Seven days later she was discharged from intensive care taking an oral calcium antagonist and warfarin. She developed intractable right heart failure and died 14 days after delivery. Despite increasing experience in the use of drugs to reduce PAP, the clinical course of pregnancy complicated by severe PPH is usually fatal.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/17. Management of pregnancy in women with pulmonary hypertension secondary to SLE and anti-phospholipid syndrome.Pulmonary hypertension is found in about 10% of patients with systemic lupus erythematosis (SLE). Pulmonary hypertension may be present at the time of diagnosis or may develop after the diagnosis of SLE or anti-phospholipid syndrome (APS). It often presents in the reproductive years and has a significant impact on pregnancy outcome, being a significant cause of indirect maternal deaths. In our observational case series of three patients there were two deaths (66%). In cases 1 and 2 the pulmonary hypertension developed during pregnancy and deteriorated rapidly with markedly abnormal mean pulmonary artery pressures of 80 and 70 mmHg respectively prior to death. Both patients died within 48 hours of delivery. In case 3 the pulmonary hypertension was milder and was diagnosed very early in pregnancy. The patient received multidisciplinary care from the first trimester and the management of the pregnancy, delivery and the early puerperium was planned. Careful epidural anaesthesia was used and the patient had invasive monitoring on the intensive therapy unit (ITU) for 72 hours. Women with pulmonary hypertension need to be aware of the high risk of maternal mortality associated with pregnancy but we believe that an improvement in outcome can be achieved by careful assessment and the use of a multidisciplinary approach from early in pregnancy.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/17. Combined spinal and epidural anaesthesia for caesarean section in a parturient with severe primary pulmonary hypertension.We describe the management of a parturient with severe primary pulmonary hypertension who underwent caesarean section. A multi-disciplinary approach was used. She was admitted to the intensive care unit perioperatively for invasive monitoring and trial of inhaled nitric oxide. Anaesthesia was provided by combined spinal-epidural block. We discuss controversies about the management of obstetric patients with this rare and serious condition.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
5/17. A fine balance--one-lung ventilation in a patient with Eisenmenger syndrome.A 38-yr-old woman with an atrial septum defect and Eisenmenger syndrome was scheduled for a lung biopsy via thoracoscopy during one-lung ventilation. Fluids were given to increase central venous pressure to 8 mm Hg, an epidural catheter was inserted at the sixth thoracic intervertebral space and ropivacaine 0.3%, 6 ml were given. Careful balance of systemic and pulmonary vascular resistance is crucial in Eisenmenger syndrome, so norepinephrine (0.14 mg kg(-1) min(-1)) was infused before general anaesthesia was started with fentanyl 4 mg kg(-1), ketamine 2 mg kg(-1), pancuronium 1 mg and succinylcholine 2 mg kg(-1). Anaesthesia was maintained with propofol 4-8 mg kg(-1) h(-1). To control pulmonary artery pressure, ventilation was performed with oxygen 100% and nitric oxide 20 ppm. Surgery and anaesthesia course were uneventful and the patient was extubated. However, pleural haemorrhage required treatment with blood components, re-intubation on the second postoperative day and removal of the haematoma by mini-thoracotomy. A step-by-step approach using a balanced combination of regional and general anaesthesia, controlled fluid administration, norepinephrine and inhaled nitric oxide preserved a stable circulation even during one-lung ventilation. The diagnostic value of lung biopsy must be weighed against the possibility of life-threatening haemorrhage.- - - - - - - - - - ranking = 3keywords = anaesthesia (Clic here for more details about this article) |
6/17. Thoracic epidural anaesthesia and primary pulmonary hypertension.patients with primary pulmonary hypertension occasionally present for surgery. Anaesthesia requires continuous cardiovascular monitoring and maintenance of stable pulmonary and systemic haemodynamics. The management of a patient with severe pulmonary hypertension, undergoing open lung biopsy under a combination of general anaesthesia and thoracic epidural analgesia is reported and the problems of primary pulmonary hypertension are discussed.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
7/17. Technique of anaesthesia in pulmonary hypertension and thrombophilia in early pregnancy.Pulmonary hypertension in pregnancy is a rare condition but is associated with a high mortality. We report the case of a 29 year old female in early pregnancy with protein c and S deficiency with recurrent deep venous thrombosis and pulmonary embolism and subsequent secondary pulmonary hypertension. The patient was counselled and consented for termination of pregnancy with tubal sterilization. She was administered continuous spinal anaesthesia with invasive monitoring. The successful anaesthetic management of this condition is described.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
8/17. Pulmonary hypertension and cardiomyopathy: anaesthetic management for caesarean section.Pulmonary hypertension in pregnant women is uncommon but is associated with a high mortality. We present the case of a 14-yr-old parturient with pulmonary hypertension and cardiomyopathy who required a Caesarean section. Management goals included: (1) maintaining right ventricular function, (2) avoiding the haemodynamic effects of general endotracheal anaesthesia, and (3) minimizing narcotic-related neonatal respiratory depression. While most authors agree on invasive pulmonary and systemic monitoring, opinions differ as to the optimal method of providing anaesthesia for these patients. The successful use of lumbar epidural anaesthesia with lidocaine and fentanyl is described. When the local anaesthetic was administered slowly and in increments, epidural anaesthesia was safe for both mother and fetus.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
9/17. alfentanil for urgent caesarean section in a patient with severe mitral stenosis and pulmonary hypertension.We present the case of a parturient with severe mitral stenosis and pulmonary hypertension who received general anaesthesia using alfentanil for urgent Caesarean section. alfentanil promoted haemodynamic stability and allowed immediate postoperative extubation. Epidural morphine provided postoperative analgesia. This combination permitted early ambulation and prevention of thromboembolism. A disadvantage of this technique, neonatal respiratory depression, was promptly reversed with a single dose of naloxone. The anaesthetic management of mitral stenosis in pregnancy is discussed and the neonatal pharmacokinetics of maternally administered alfentanil are presented.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
10/17. life-threatening complications during anaesthesia in a patient with a ventriculo-atrial shunt and pulmonary hypertension.A 6-year-old patient with hydrocephalus who underwent revision of a ventriculo-atrial shunt is described. Anaesthesia was complicated by the occurrence of systemic hypertension and arterial hypoxaemia. The patient was subsequently found to have pulmonary hypertension secondary to recurrent pulmonary thromboembolism. The pathophysiological mechanisms for the patient's deterioration are discussed and the anaesthetic management of children with pulmonary hypertension is outlined. It is concluded that patients with a ventriculo-atrial shunt who present for surgery should be screened carefully for the presence of pulmonary hypertension.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
| | Next -> |