İsmail Serhat KOCAMANOĞLU, Sibel BARIŞ, Deniz KARAKAYA, Ayla TÜR, Haydar ŞAHİNOĞLU, Emre ÜSTÜN, Bengi ŞENER, Mehmet ÇETİNKAYA

Low dose spinal anesthesia for caesarean section in a patient with peripartum dilated cardiomyopathy

Yirmi sekiz haftalık gebe hastaya Peripartum Dilate Kardiyomiyopati tanısıyla medikal tedavi başlanmıştı. Bu hastada gebeliğinin 38. Haftasında, epidural kateter de yerleştirmek suretiyle düşük-doz spinal anestezi altında acil sezaryen operasyonu gerçekleştirildi. Spinal anestezi sezaryen ameliyatı için yeterli analjezi sağladı. Kalp hızı, kan basıncı, santral venöz basınç ve periferik oksijen satürasyonu monitörize edilerek sürekli gözlendi. Operasyon süresince hemodinamik ve solunumsal parametreler stabil seyretti. Postoperatif komplikasyon gelişmedi. Epidural kateter postoperatif analjezi amacıyla kullanıldı.

Anahtar Kelimeler:

Erişkin, Anestezi, spinal, Sezaryen, Gebelik, Kardiyomiyopati, konjestif

The patient with peripartum dilated cardiomyopathy (PPCM) was diagnosed at 28 wks gestation, and treated. Emergent caesarean section (C/S) was performed at 38 wks gestation under low dose spinal anesthesia combined with epidural catheter. Spinal anesthesia provides sufficient analgesia for C/S operation. Heart rate, blood pressure, central venous pressure and peripheral oxygen saturation were monitored continuously. Hemodynamic and respiratory parameters remained stable during the operation. No postoperative complications occurred. The epidural ,catheter was used for postoperative analgesia.

Keywords:

Adult, Anesthesia, Spinal, Cesarean Section, Pregnancy, Cardiomyopathy, Congestive,

___

1. Braun CS, Bertolet BD. Peripartum cardiomyopathy : a comprehensive review. Am J Obstet Gynecol 1998; , 178: 409-414. 2. Chan F, Ngan Kee WD. Idiopathic dilated cardiomyo¬ pathy presenting in pregnancy. Can J Anaesth 1999; 46: 1146-1149. 3. George LM, Gatt SP, Lowe S. Peripartum cardiomyopathy: Four case histories and a commentary on anaesthetic management. Anaesth Intens Care 1997; 25: 292-296. 4. Camann WR, Thornhill ML. Cardiovascular disease. In: Chestnut DH, ed. Obstetric Anesthesia: Principles and Practice, 2nd ed. St.Louis: Mosby, 1999; 776-808. 5. Mclndoe AK, Hammond EJ, Babington R. Peripartum cardiomyopathy presenting as a cardiac arrest at in¬duction of anesthesia for emergency caesarean secti¬on. Br J Anaesth 1995; 75: 97-101. 6. Kanmura Y, Hagihira M, Higashi M, et al. Anesthetic management of caesarean section in a patient with di¬lated cardiomyopathy. Masui 1995; 44: 407-410. 7. Rawal N, Schollin J, Wesstrom G. Epidural versus combined spinal-epidural block for caesarean section. Acta Anaesthesiol Scand 1988; 32: 61-66. 8. VercautererrMP, Coppejans HC, Hoffmann VL, Saldi- en V, Adriaensen HA. Small-dose hyperbaric versus plain bupivacaine during spinal anesthesia for caesa¬ rean section. Anesth Analg 1998; 86: 989-993. 9. Kestin IG. Spinal anaesthesia in obstetrics. Br J Ana¬ esth 1991; 66: 596-607.