Abstract
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.
Résumé
L’hypertension pulmonaire chez les femmes enceintes n’est pas fréquente, mais elle est associée à un taux élevé de mortalité. On présente le cas d’une parturiente de 14 ans atteinte d’hypertension pulmonaire et d’une cardiomyopathie qui a requis une césarienne. Le plan d’action incluait: 1) le maintien de la fonction ventriculaire droite, 2) le contrôle des effets hémodynamiques de l’anesthésie générale endotrachéale et 3) le contrôle de la dépression respiratoire néonatale reliée aux narcotiques. Alors que la majorité des auteurs s’accordent sur la surveillance systémique et pulmonaire invasive, les opinions divergent sur la méthode optimale de fournir l’anesthesie à ces patientes. L’utilisation avec succès de l’anesthésie épidurale lombaire avec de la lidocaïne et du fentanyl est décrite. Quand l’anesthésique local fut administré lentement et avec des doses de rajouts, l’anesthésie épidurale fut sécuritaire tant pour la mère que pour le foetus.
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Breen, T.W., Janzen, J.A. Pulmonary hypertension and cardiomyopathy: anaesthetic management for Caesarean section. Can J Anaesth 38, 895–899 (1991). https://doi.org/10.1007/BF03036969
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DOI: https://doi.org/10.1007/BF03036969