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Revista Cubana de Anestesiología y Reanimación

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Revista Cubana de Anestesiología y Reanimación
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2021, Number 1

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Revista Cubana de Anestesiología y Reanimación 2021; 20 (1)

Perioperative anesthetic management in term pregnant women with idiopathic pulmonary hypertension

Dávila CSF, Martínez CLL, Hernández RMA, Guerra RL, Montenegro VA
Full text How to cite this article

Language: Spanish
References: 21
Page: 1-7
PDF size: 381.55 Kb.


Key words:

idiopathic pulmonary arterial hypertension, pregnant woman, echocardiography, anesthetic technique.

ABSTRACT

Introduction: Pulmonary arterial hypertension is a disease with low incidence in the pregnant woman, although it brings about high mortality once presented. Timely diagnosis and adequate perioeprative management minimize the risk of fatal outcome for both mother and fetus.
Objective: To describe pulmonary arterial hypertension and its anesthetic management in the term pregnant woman.
Case presentation: 23-year-old female patient, with health history and gestational age of 35.2 weeks. After presenting back pain and chest burning associated with exertion, palpitations, dyspnea and right bundle branch block in the electrocardiogram, the patient was admitted to the intensive care unit with suspected pulmonary thromboembolism, which was ruled out due to the confirmatory diagnosis of pulmonary hypertension after performing computerized tomography angiography and echocardiography. Scheduled cesarean section was decided to be perform using the regional peridural technique, without complications for both the mother and the child. After two days under intensive surveillance, she was transferred to her primary hospital.
Conclusions: The route of delivery, as well as an adequate choice of the anesthetic technique, can be the difference between success and fatality. Regional techniques are usually recommended over the general anesthesia technique, as long as there are no contraindications.


REFERENCES

  1. Garabedian MJ, Hansen WF, Gianferrari EA. Epo-prostenol treatment for idiopathic pulmonary arterial hypertension in pregnancy. J Perinatol. 2010;30(9):628-631. https://doi.org/10.1038/jp.2010.15

  2. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, ESC Scientific Document Group. ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-241

  3. Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: A systematic overview from 1978 through 1996. J Am CollCardiol. 1998;31:1650-7.

  4. Liu H, Huang TT, Lin JH. Risk factors and risk index of cardiac events in pregnant women with heart disease. Chin Med J (Engl). 2012;125:3410-15.

  5. Javed Khan, Majdy M. Idrees, saudi guidelines on the diagnosis and treatment of pulmonary hypertension: pregnancy in pulmonary hypertension. Annals of Thoracic Medicine. 2014;9(Suppl 1). http://doi.org/10.4103/1817-1737.134050

  6. Simonneau G. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019;53:1801913. https://doi.org/10.1183/13993003.01913-2018

  7. Anthony J, Sliwa K. Decompensated heart failure in pregnancy. Card Fail Rev. 2016;2(1):20-26. http://doi.org/10.15420/cfr.2015:24:2

  8. Silversides CK, Grewal J, Mason J. Pregnancy outcomes in women with heart disease: the CARPREG II Study. J Am Coll Cardiol. 2018;71(21):2419-30. http://doi.org/10.1016/j.jacc.2018.02.076

  9. Siu SC. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515-21.

  10. Ruys TP. Heart failure in pregnant women with cardiac disease: Data from the ropac. Heart. 2014;100:231-38.

  11. Drenthen W. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J. 2010;31:2124-32.

  12. Patel MB, Kellerhals S, Horton JP, Fisher MR, Krishna I, Badell ML. Pulmonary Arterial Hypertension in Pregnancy: Outline of Multidisciplinary Care. Cur Op Gyn Obs. 2019; 2(1):346-53.

  13. Kiely DG, Condliffe R, Wilson VJ, Gandhi SV, Elliot CA. Pregnancy and pulmonary hypertension: a practical approach to management. Obstet Med. 2013;6(4):144-54. http://doi.org/10.1177/1753495X13495193

  14. Kayle SS, Nihar RD, Robert WE, Heather SL, Josephine CC, Erica SS. Cardio-obstetrics: Recognizing and managing cardiovascular complications of pregnancy. Cleveland clinic journal of medicine. 2020;87(1). http://doi.org/10.3949/ccjm.87a.18137

  15. McGlothlin D, Ivascu N, Heerdt PM. Anesthesia and pulmonary hypertension. Prog Cardiovasc Dis. 2012;55:199-217.

  16. Lin DM, Lu JK. Anesthetic management in pregnant patients with severe idiopathic pulmonary arterial hypertension. International Journal of Obstetric Anesthesia. 2014;23(3):289-90.

  17. Viktorsdottir O. Pulmonary hypertension in pregnancy and anesthetic implications. Current Anesthesiology Reports. 2015;5(1):82-90.

  18. Mostert. E. An approach to the pregnant patient with pulmonary hypertension. Southern African Journal of Anaesthesia and Analgesia. 2018;24(3)(Suppl 1). ISSN 2220-1181.

  19. Maxwell BG, Pearl RG, Kudelko KT, Case 7-2012. Airway management and perioperative decision making in the patient with severe pulmonary hypertension who requires emergency noncardiac surgery. J Cardiothorac Vasc Anesth. 2012;26:940-44.

  20. Susan RW, Christopher K, Richard NC. Pulmonary hypertension and right ventricular failure in emergency medicine. Annals of Emergency Medicine. 2015. http://dx.doi.org/10.1016/j.annemergmed.2015.07.525

  21. Bhavna G, Kamna K, Lalit G, Anish G. Anesthetic considerations for a parturient with pulmonary hypertension. The Indian Anaesthetists' Forum. 2017;18(2). http://doi.org/10.4103/TheIAForum.TheIAForum2817




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Revista Cubana de Anestesiología y Reanimación. 2021;20