Continuous spinal anesthesia and postoperative analgesia for elective cesarean section in a parturient with Eisenmenger's syndrome

Shigeki Sakuraba, Shuya Kiyama, Ryoichi Ochiai, Shinichi Yamamoto, Tatsuya Yamada, Saori Hashiguchi, Junzo Takeda

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

We describe the use of continuous spinal anesthesia (CSA) for an elective cesarean section in a 29-year-old parturient with Eisenmenger's syndrome at 30 weeks of gestation. It is essential in patients with Eisenmenger's syndrome to prevent significant increases in right-to-left shunt following the reduction in systemic vascular resistance. In this case, the patient hoped to be awake during the operation because of her fear of death. We therefore applied CSA to this patient because single-shot spinal anesthesia and epidural anesthesia might cause sudden cardiovascular depression. In fact, sudden cardiovascular changes were avoided by the titration of local anesthetics and the operation was uneventful, although prompt treatment of hypotension was essential and adjustment of the anesthetic levels was difficult. Postoperative patient-controlled spinal analgesia provided satisfactory pain relief with hemodynamic stability and no significant side effects. However, thorough experience with the requisite techniques is critical in CSA because of the technical difficulty of the procedure, and anesthesiologists must gain such experience in less-demanding cases before attempting to administer it in patients presenting extreme challenges as described in this case report.

Original languageEnglish
Pages (from-to)300-303
Number of pages4
JournalJournal of Anesthesia
Volume18
Issue number4
DOIs
Publication statusPublished - 2004 Nov

Keywords

  • Cesarean section
  • Continuous spinal anesthesia
  • Eisenmenger's syndrome
  • Obstetric
  • Subarachnoid

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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