oa Southern African Journal of Anaesthesia and Analgesia - Caesarean section in Eisenmenger's syndrome : anaesthetic management with titrated epidural and nebulised alprostadil : case report
|Article Title||Caesarean section in Eisenmenger's syndrome : anaesthetic management with titrated epidural and nebulised alprostadil : case report|
|© Publisher:||Medpharm Publications|
|Journal||Southern African Journal of Anaesthesia and Analgesia|
|Affiliations||1 RG Kar Medical College and Hospital, India, 2 RG Kar Medical College and Hospital, India, 3 The Institute of Post-Graduate Medical Education and Research, India and 4 Calcutta National Medical College, India|
|Publication Date||Jan 2016|
|Pages||65 - 67|
|Keyword(s)||Alprostadil, Caesarean section, Eisenmenger's syndrome and Epidural|
Pregnancy in patients with Eisenmenger's syndrome is associated with a high mortality. This article reports two cases of women with Eisenmenger's syndrome (secondary to two different primary cardiac defects) who presented with near-term pregnancies. Both the patients underwent successful elective Caesarean section with slowly titrated epidural anaesthesia. Nebulised prostaglandin E1(PGE1) analogue, alprostadil, administered immediately post-delivery resulted in a significant drop in systolic pulmonary artery pressures as measured from tricuspid regurgitant jet by transthoracic echocardiography. The postoperative period was uneventful in both patients. A slow induction of epidural anaesthesia can be a safe mode of anaesthesia for Caesarean section in pregnant patients with Eisenmenger's syndrome. Nebulised alprostadil intraoperatively or postoperatively in the intensive care unit (ICU) is readily available and a relatively cheap option as a selective pulmonary vasodilator in developing countries.
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