Abstract
Purpose
To evaluate the effects of intrathecal analgesics on cardiac function during labour analgesia using echocardiography in a parturient with idiopathic dilated cardiomyopathy (DCM).
Clinical features
Induction of labour was planned in a 35-yr-old primiparous woman suffering from DCM. In order to stabilize hemodynamics in this patient, we induced continuous spinal analgesia with an infusion of fentanyl and epinephrine. Although her analgesia was well maintained for three hours during the first stage of labour, the patient complained of pain towards the second stage of labour. At this point, we administered bupivacaine intrathecally to alleviate her pain. Transthoracic echocardiography showed that the left ventricular end-diastolic and systolic dimensions, as well as the ejection fraction were not impaired by use of these analgesic medications.
Conclusion
Measurement of left ventricular dimensions by echocardiography allowed us to monitor the patient’s response to intrathecal analgesic medications. In this patient with DCM, analgesia with intrathecal fentanyl and bupivacaine was well tolerated.
Résumé
Objectif
Évaluer les effets d’analgésiques intrathécaux sur la fonction cardiaque pendant le travail en utilisant l’échocardiographie chez une patiente qui présente une insuffisance cardiaque primitive (ICP).
Éléments cliniques
L’induction du travail était planifiée chez une primipare de 35 ans souffrant d’ICP. Une rachianalgésie continue avec une perfusion de fentanyl et d’épinéphrine a été induite pour stabiliser l’hémodynamique. L’analgésie avait été bien maintenue pendant trois heures au cours de la première phase du travail, mais la patiente a eu des douleurs pendant la seconde phase. Nous avons donc donné de la bupivacaïne intrathécale. L’échocardiographie transthoracique a montré que les dimensions télédiastoliques et systoliques du ventricule gauche, de même que la fraction d’éjection, n’étaient pas atteintes par l’usage de ces analgésiques.
Conclusion
La mesure des dimensions du ventricule gauche par échocardiographie a permis de vérifier la réaction à l’analgésique intrathécal. L’administration intrathécale de fentanyl et de bupivacaïne a été bien tolérée chez cette patiente atteinte d’ICP.
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References
Shnaider R, Ezri T, Szmuk P, Larson S, Warters RD, Katz J. Combined spinal-epidural anesthesia for cesarean section in a patient with peripartum dilated cardiomyopathy. Can J Anesth 2001; 48:681–3.
Gambling DR, Flanagan ML, Huckell VF, Lucas SB, Kim JH. Anaesthetic management and non-invasive monitoring for caesarean section in a patient with cardiomyopathy. Can J Anaesth 1987; 34:505–8.
Bernstein PS, Magriples U. Cardiomyopathy in pregnancy: a retrospective study. Am J Perinatol 2001; 18:163–8.
Honet JE, Arkoosh VA, Norris MC, Huffnagle HJ, Silverman NS, Leighton BL. Comparison among intrathecal fentanyl, meperidine, and sufentanil for labor analgesia. Anesth Analg 1992; 75:734–9.
Gaiser RR, Cheek TG, Gutsche BB. Comparison of three different doses of intrathecal fentanyl and sufentanil for labor analgesia. J Clin Anesth 1998; 10:488–93.
Bromage PR, Camporesi EM, Durant PA, Nielsen CH. Influence of epinephrine as an adjuvant to epidural morphine. Anesthesiology 1983; 58:257–62.
Kadoi Y, Koike T, Fujita N. Anesthetic management of a patient with dilated cardiomyopathy (Japanese). Masui 1996; 45:1002–4.
Kuroda T, Shiina A, Suzuki O, et al. Prediction of prognosis of patients with idiopathic dilated cardiomyopathy: a comparison of echocardiography with cardiac catheterization. Jpn J Med 1989; 28:180–8.
Doi YL, Chikamori T, Tukata J, et al. Prognostic value of thallium-201 perfusion defects in idiopathic dilated cardiomyopathy. Am J Cardiol 1991; 67:188–93.
Muralidhar V, Kaul HL, Mallick P. Over-the-needle versus microcatheter-through-needle technique for continuous spinal anesthesia: a preliminary study. Reg Anesth Pain Med 1999; 24:417–21.
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Okutomi, T., Saito, M., Amano, K. et al. Labour analgesia guided by echocardiography in a parturient with primary dilated cardiomyopathy. Can J Anesth 52, 622–625 (2005). https://doi.org/10.1007/BF03015773
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DOI: https://doi.org/10.1007/BF03015773