[Anesthetic management of a pregnant patient with congenitally corrected transposition of the great arteries for emergency cesarean delivery].
A 30-year-old woman at 35 weeks' gestation with congenitally corrected transposition of the great arteries (CCTGA), whose associated anomalies were VSD, ASD and pulmonary stenosis, underwent emergency cesarean delivery under general anesthesia. She had hypoxemia due to right-to-left shunt. We discussed with obstetricians and pediatric cardiologists about her at 25 weeks' gestation. Discussed points included: 1) delivery after 30 weeks' gestation, 2) her cardiac function and anomalies, 3) cesarean delivery under general anesthesia in case of emergency, 4) management of a sleeping baby after cesarean delivery by pediatricians. Cyanosis and heart failure were noted worsening during pregnancy. General anesthesia was induced by midazolam and fentanyl following cannulation of radial artery and right internal jugular vein for blood pressure and CVP monitoring. Anesthesia was maintained with sevoflurane and fentnyl. Dopamine and dobutamine were used to support blood pressure and cardiac function. After delivery, because of decreased CVP, lactated Ringer's solution was administrated. After operation, the patient was hemodynamically stable and trachea was extubated. Anesthetic management of the patient depends on the anatomical defects of CCTGA and associated conditions. Anesthesiologist should obtain information about a pregnant woman with CCTGA from cardiologists and obstetricians in early gestation to manage patient successfully.
Tsuda
Atsushi
A
Department of Anesthesia, National Nagasaki Medical Center, Omura 856-8562.
Nagaoka
Kyoko
K
Hashiguchi
Hideo
H
Shibata
Shigeki
S
Shibata
Itsuko
I
Nagatani
Atsuko
A
D000328:Adult; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical / Q000379:methods*; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications; D006345:Heart Septal Defects, Ventricular / Q000150:complications; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011666:Pulmonary Valve Stenosis / Q000150:complications; D014188:Transposition of Great Vessels / Q000150:complications*