title: Continuous spinal analgesia for labor and delivery in a parturient with hypertrophic obstructive cardiomyopathy.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. toshiyukiokutomi@hotmail.com
authors.forename: T
authors.initials: T
authors.lastname: Okutomi
authors.forename: S
authors.initials: S
authors.lastname: Kikuchi
authors.forename: K
authors.initials: K
authors.lastname: Amano
authors.forename: H
authors.initials: H
authors.lastname: Okamoto
authors.forename: S
authors.initials: S
authors.lastname: Hoka
mesh_terms: 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
chemical_list: D000701:Analgesics, Opioid; D008614:Meperidine; D005283:Fentanyl