Düşük Doz Kombine Spinal Epidural: Doğuştan Düzeltilmiş Büyük Arter Transpozisyonu ve Şiddetli Pulmoner Stenozu olan Hastada Sezaryen için Bir Anestezi Tekniği
22 yaşında 39. gebelik haftasında bir primigravid, doğumun başlamasından itibaren dispne ile hastaneye yatırıldı. Sistemik değerlendirme ve ekokardiyografide, ciddi pulmoner stenoz ve çift yönlü atriyal ve ventriküler septal defekt ile konjenital düzeltilmiş büyük arter transpozisyonu (CCTGA) tanısı konuldu. Multidisipliner bir ekip ilk semptomatik yönetimi sağladı, riski sınıflandırdı ve sezaryen için plan yaptı. Hem intraoperatif hem de postoperatif stabil hemodinami ile mükemmel cerrahi koşul sağlayan düşük doz sıralı kombine spinal epidural anestezi invaziv monitorizasyon ile kullanıldı.
Low Dose Combined Spinal-Epidural Anesthesia: An Anesthesia Technique for Cesarean Section in a Patient Suffering from Congenitally Corrected Transposition of Great Arteries and Severe Pulmonary Stenosis
A primigravida, aged 22 years, at 39th gestational week was hospitalized with dyspnea sinceonset of labor. On systemic evaluation and echocardiography, she was diagnosed to have congenitally corrected transposition of the great arteries (CCTGA) along with severe pulmonicstenosis and bidirectional ventricular and atrial septal defects. A multidisciplinary team provided initial symptomatic management, stratified the risk and planned for a cesarean section.A low-dose combined sequential spinal-epidural anesthesia with invasive monitoring was usedwhich provided excellent surgical condition with stable intraoperative and postoperative hemodynamics.
___
- 1. Warnes CA. Congenitally corrected transposition: the uncorrected misnomer. J Am Coll Cardiol. 1996;27:1244-5. https://doi.org/10.1016/0735-1097(96)00037-X
- 2. Therrien J, Barnes I, Somerville J. Outcome of pregnancy in patients with congenitally corrected transposition of the great arteries. Am J Cardiol. 1999;84:820-4. https://doi.org/10.1016/S0002-9149(99)00444-0
- 3. Connolly HM, Grogan M, Warnes CA. Pregnancy among women with congenitally corrected transposition of great arteries. J Am Coll Cardiol. 1999;33:1692-5. https://doi.org/10.1016/S0735-1097(99)00046-7
- 4. Connelly MS, Liu PP, Williams WG, Webb GD, Robertson P, McLaughlin PR. Congenitally corrected transposition in the adult: functional status and complications. J Am Coil Cardiol. 1996;27:1238-43. https://doi.org/10.1016/0735-1097(95)00567-6
- 5. Graham TP Jr., Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study. J Am Coll Cardiol. 2000;36:255-61. https://doi.org/10.1358/dot.2000.36.4.570204
- 6. Cole PL, St. John Sutton M. Normal cardiopulmonary adjustments to pregnancy: Cardiovascular evaluation. Cardiovasc Clin. 1989: 19:37.
- 7. Brickner ME. Cardiovascular management in pregnancy: Congenital heart disease. Circulation. 2014;130:273-82. https://doi.org/10.1161/CIRCULATIONAHA.113.002105
- 8. Parneix M, Fanou L, Morau E, Colson P. Low-dose combined spinal-epidural anaesthesia for caesarean section in a patient with Eisenmenger’s syndrome. Int J Obstet Anesth. 2009;18:81-4. https://doi.org/10.1016/j.ijoa.2008.08.003
- 9. Cole PJ, Cross MH, Dresner M. Incremental spinal anaesthesia for elective caesarean section in a patient with Eisenmenger’s syndrome. Br J Anaesth. 2001;86:723-6. https://doi.org/10.1093/bja/86.5.723
- 10. Martin JT, Tautz TJ, Antognini JF. Safety of regional anesthesia in Eisenmenger’s syndrome. Reg Anesth Pain Med. 2002;27:509-13. https://doi.org/10.1053/rapm.2002.35706
- 11. Ng K, Parsons J, Cyna AM, Middleton P. Spinal versus epidural anaesthesia for caesarean section. Cochrane Database Syst Rev. 2004;CD003765. https://doi.org/10.1002/14651858.CD003765.pub2
- 12. Tyagi A, Sharma CS, Kumar D, Sharma DK, Jain AK, Sethi AK. Epidural volume extension: A review. Anaesth Intensive Care. 2012;40:604-13. https://doi.org/10.1177/0310057X1204000405
- 13. Hamlyn EL, Douglass CA, Plaat F, Crowhurst JA, Stocks GM. Low-dose sequential combined spinal-epidural: An anaesthetic technique for caesarean section in patients with significant cardiac disease. Int J Obstet Anesth. 2005;14:355-61. https://doi.org/10.1142/S021827180500513X
- 14. Landau R, Giraud R, Morales M, Kern C, Trindade P. Sequential combined spinal-epidural anesthesia for cesarean section in a woman with a double-outlet right ventricle. Acta Anaesthesiol Scand 2004;48:922-6. volume extension: A review. Anaesth Intensive Care. 2012;40:604-13. https://doi.org/10.1177/0310057X1204000405
- 15. Solanki SL, Jain A, Singh A, Sharma A. Low-dose sequential combined-spinal epidural anesthesia for Cesarean section in patient with uncorrected tetrology of Fallot. Saudi J Anaesth. 2011;5:320-2. https://doi.org/10.4103/1658-354X.84111
- 16. Parniex M, Fanou L, Morau E, Colson P. Low-dose combined spinal-epidural anaesthesia for caesarean section in a patient with Eisenmenger’s syndrome. Int J of Obstet Anesth. 2009;18:81-4. https://doi.org/10.1016/j.ijoa.2008.08.003
- 17. Han Y, Zhang Z, Sun Q, et al. Combined spinal-epidural anesthesia for cesarean delivery in a patient with cor triloculare biventriculare. BMC Anesthesiol. 2017;17:115. https://doi.org/10.1186/s12871-017-0411-6
- 18. Tawfik MM, Hafez H, Abdelkhalek M, Allakkany NS. Combined spinal-epidural anesthesia for cesarean section in a parturient with congenitally corrected transposition of the great arteries. J Anaesthesiol Clin Pharmacol. 2017;33:418-20. https://doi.org/10.4103/0970-9185.168265