CLINICAL CASES Free access

Minerva Anestesiologica 2005 May;71(5):227-36

Copyright © 2005 EDIZIONI MINERVA MEDICA

language: English, Italian

Different anesthesiological management in two high risk pregnant women with heart failure undergoing emergency cesarean section

Zangrillo A. ¹, Landoni G. ¹, Pappalardo F. ¹, Oppizzi M. ², Torri G. ¹

¹ Department of Anesthesiology, Vita-Salute University of Milan, IRCCS San Raffaele Hospital Milan, Italy 2 Department of Cardiology Vita-Salute University of Milan IRCCS San Raffaele Hospital, Milan, Italy

Pregnancy exacerbates heart diseases. The aim of this clinical report is to review the different anesthesiological management of emergent cesarean section in 2 patients with heart failure. The pathophysiology of heart failure is described according to the primary cause of disease, as well as the impact of 2 different anesthetic techniques. Two case reports of a university referral hospital are presented. Both patients left the hospital in good general conditions. Case 1: a pregnant patient with severe aortic regurgitation who received epidural anesthesia. Case 2: a pregnant patient with peripartum cardiomyopathy who was given general anesthesia. Medical and surgical therapies for aortic regurgitation and peripartum dilated cardiomyopathy are evolving. Adequate knowledge of anesthesiology is required to appropriately manage these cases. We tailored the anesthetic technique to the specific characteristics of our 2 patients. The beneficial effects of sympathectomy were observed in the postoperative period of case 1; the use of high doses opiates minimised dangerous cardiovascular changes in case 2, but rapid resuscitation of the baby should be available. Selection of the anesthetic technique in obstetrics is the most challenging issue for the anesthesiologist: extensive knowledge of the pathophysiology of heart disease is required for an optimal choice.