Continuous spinal analgesia for labor and delivery in a parturient with hypertrophic obstructive cardiomyopathy.
Induction of labor under analgesia was planned for a 30-year-old-primiparous patient with hypertrophic obstructive cardiomyopathy (HOCM), as her fetal evaluation revealed intrauterine growth restriction at 38 weeks' gestation. However, regional analgesia during labor may present a potential risk for hemodynamic instability in patients with HOCM due to the possibility of a sympathetic block, as a result of vasodilation associated with the administration of local anesthesia. This case report demonstrates the successful management of the patient with analgesia provided by a continuous spinal catheter dosed with a continuous infusion of fentanyl and supplemental meperidine. Fetal surveillance monitoring included fetal pulse oximetry in addition to conventional cardiotocography, on the basis of which cesarean section was avoided.
Okutomi
T
T
Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. toshiyukiokutomi@hotmail.com
Kikuchi
S
S
Amano
K
K
Okamoto
H
H
Hoka
S
S
D000328:Adult; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid; D000775:Anesthesia, Spinal; D002312:Cardiomyopathy, Hypertrophic; D005260:Female; D005283:Fentanyl; D005323:Fetal Monitoring; D006801:Humans; D008614:Meperidine; D010147:Pain Measurement; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular
D000701:Analgesics, Opioid; D008614:Meperidine; D005283:Fentanyl