Düzeltilmiş Fallot Tetralojisi Olan Gebede Sezaryen İçin Epidural Anestezi Deneyimimiz: Olgu Sunumu

Fallot tetralojisi (TOF) gebelikte en sık karşılaşılan siyanotik konjenital kalp hastalığıdır. TOF’un cerrahi onarımından sonraki gebelik olgularının çoğu kardiyovasküler ve obstetrik kaygılara odaklanmışken, nispeten az sayıda yazar anestezik yönetim stratejilerine odaklanmıştır. Bu hastalarda anestezi seçimi çok zordur ve güncel öneriler sadece bildirilen klinik deneyimlere ve patofizyolojik kavramlara dayanmaktadır. Bu olgu sunumunda düzeltilmiş TOF cerrahisi geçiren 37 haftalık gebede, sezaryen cerrahisi için uygulanan epidural anestezi deneyimimizi paylaşmayı amaçladık. Sonuç olarak, TOF onarımı olan gebelerde bölünmüş ve artan dozlarda yavaş etkili bupivakain ile epidural anestezi uygulamasının, etkili kardiyovasküler stabilite ile iyi anestezi elde etmek için güvenli bir alternatif olduğunu düşünüyoruz.

Our Experience of Epidural Anesthesia for Cesarean Section in Pregnant Woman with Corrected Tetralogy of Fallot: A Case Report

Tetralogy of Fallot (TOF) is the most commonly encountered cyanotic congenital cardiac disease in pregnancy. While most pregnancy cases after surgical repair of TOF have focused on cardiovascular and obstetric concerns, few authors have focused on anesthetic management strategies. Determining the type of anesthesia in these patients is very difficult, and current recommendations are based solely on reported pathophysiological concepts and clinical experiences. In this case report, we aimed to share our epidural anesthesia experience for cesarean surgery in a 37-week pregnant woman with corrected TOF surgery. In conclusion, we suppose that application of epidural anesthesia with divided and increasing doses of slow-acting bupivacaine in pregnant women with repaired TOF is a safe alternative to achieve good anesthesia with effective cardiovascular stability.

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1. Lake CL, editor. 3rd ed. Stamford, CT: Appleton and Lange; 1998. Paediatric cardiac anaesthesia .Stamford, CT: Appleton and Lange, 1998; 305-306.
2. Arendt KW, Fernandes SM, Khairy P, Warnes CA, Rose CH, Landzberg MJ, Craigo PA, Hebl JR. A case series of the anesthetic management of parturients with surgically repaired tetralogy of fallot. Anesth Analg 2011;113:307–317.
3. Yeomans ER, Gilpstrap LC. Physiologic changes in pregnancy and their impact on critical care. Crit Care Med 2005;33:256- 258.
4. Lin CH, Lee CN. Atrial fibrillation with rapid ventricular response in pregnancy. Taiwan J Obstet Gynecol 2008;47:327-323.
5. Pedersen LM, Pedersen TA, Ravn HB, Hjortdal VE. Outcomes of pregnancy in women with tetralogy of Fallot. Cardiol Young 2008; 18: 423-429.
6. Veldtman GR, Connolly HM, Grogan M, Ammash NM, Warnes CA. Outcomes of pregnancy in women with tetralogy of Fallot. J Am Coll Cardiol 2004;44:174-180.
7. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP Jr, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Writing Committee to Develop Guidelines on the Management of Adults with Congenital Heart Disease): Developed in collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008;118: e714-833.
8. Gomar C, Errando CL. Neuroaxial anaesthesia in obstetrical patients with cardiac disease. Curr Opin Anaesthesiol 2005;18:507-512.
9. Siu SC, Colman JM. Heart disease and pregnancy. Heart 2001;85:710.
10. 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;14:355-361.
11. Karaçam Z. Normal postpartum dönemin fizyolojisi ve bakımı. Şirin A, Kavlak O, editörler. Kadın Sağlığı. Genişletilmiş 2. Baskı. İstanbul: Nobel Tıp Kitabevleri; 2015. 460-87.
12. World Health Organization (WHO). Recommendations on postnatal care of the mother and newborn, a practical guide, 2013. Geneva: WHO. ISBN:9789241506649. 2013.