title: Intrathecal fentanyl/meperidine combined with low-dose epidural bupivacaine for Cesarean section in a patient with advanced Krukenberg tumors.
abstract: This case report demonstrates the anesthetic management of a 41-year-old primiparous parturient with massive ascites due to advanced Krukenberg tumors, undergoing Cesarean section. We chose a combined intrathecal-epidural technique, using intrathecal hypobaric fentanyl and hyperbaric meperidine, and a low dose of epidural bupivacaine in order to avoid hemodynamic instability in this critically ill patient. Surgery was carried out without difficulty under adequate regional anesthesia. The blood pressure was maintained with low doses of phenylephrine and dopamine. Opioid-related complications such as nausea-vomiting, pruritus, drowsiness, and respiratory depression were not observed in this patient. Therefore, intrathecal opioids combined with a low dose of epidural local anesthetics for Cesarean section is suitable for critically ill patients with malignant abdominal tumors, such as a Krukenberg tumor, complicated by massive ascites.
authors.affiliation: Departments of Anesthesiology, Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. toshiyukiokutomi@hotmail.com
authors.forename: T
authors.initials: T
authors.lastname: Okutomi
authors.forename: Y
authors.initials: Y
authors.lastname: Hoshino
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: D000759:Adjuvants, Anesthesia / Q000627:therapeutic use*; D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D019162:Anesthetics, Combined / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D002585:Cesarean Section; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D007278:Injections, Spinal; D007725:Krukenberg Tumor / Q000150:complications*; D008614:Meperidine / Q000627:therapeutic use*; D010051:Ovarian Neoplasms / Q000150:complications*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000503:physiopathology*
chemical_list: D000759:Adjuvants, Anesthesia; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008614:Meperidine; D005283:Fentanyl; D002045:Bupivacaine