title: Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy.
abstract: OBJECTIVE
  To report a case of peripartum dilated cardiomyopathy associated with morbid obesity and possible difficult airway presenting for elective Cesarean section, which was successfully managed with combined spinal-epidural anesthesia.
  
  
  METHODS
  A morbidly obese parturient with a potentially difficult airway, suffering from idiopathic peripartum cardiomyopathy (ejection fraction 20%), was scheduled for an elective Cesarean section. A combined spinal epidural anesthesia was performed and 6 mg of bupivacaine were injected into the subarachnoid space. This was supplemented after 60 min with 25 mg of bupivacaine injected epidurally. The patient's hemodynamic status was monitored with direct intra-arterial blood pressure and central venous pressure measurements. The patient's perioperative course was uneventful.
  
  
  CONCLUSIONS
  In patients suffering from peripartum cardiomyopathy, undergoing Cesarean section, combined spinal-epidural anesthesia may be an acceptable anesthetic alternative.
authors.affiliation: Department of Anesthesiology University of Texas Medical School at Houston, Houston, Texas 77030, USA.
authors.forename: R
authors.initials: R
authors.lastname: Shnaider
authors.forename: T
authors.initials: T
authors.lastname: Ezri
authors.forename: P
authors.initials: P
authors.lastname: Szmuk
authors.forename: S
authors.initials: S
authors.lastname: Larson
authors.forename: R D
authors.initials: RD
authors.lastname: Warters
authors.forename: J
authors.initials: J
authors.lastname: Katz
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000775:Anesthesia, Spinal; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D002585:Cesarean Section; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal; D009767:Obesity, Morbid; D007744:Obstetric Labor Complications / Q000628:therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology*