Combined spinal and epidural anaesthesia for caesarean section in a parturient with severe primary pulmonary hypertension.
We describe the management of a parturient with severe primary pulmonary hypertension who underwent caesarean section. A multi-disciplinary approach was used. She was admitted to the intensive care unit perioperatively for invasive monitoring and trial of inhaled nitric oxide. Anaesthesia was provided by combined spinal-epidural block. We discuss controversies about the management of obstetric patients with this rare and serious condition.
Duggan
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AB
Division of Anaesthesia and Intensive Care, Prince of Wales Hospital, N.S.W.
Katz
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SG
D000322:Adrenergic Agonists / Q000627:therapeutic use; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D019162:Anesthetics, Combined / Q000627:therapeutic use; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D002585:Cesarean Section; D004280:Dobutamine / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D009020:Morphine / Q000627:therapeutic use; D009609:Nitrous Oxide / Q000627:therapeutic use; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy / Q000503:physiopathology; D012720:Severity of Illness Index
D000322:Adrenergic Agonists; D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D004280:Dobutamine; D009020:Morphine; D009609:Nitrous Oxide; D005283:Fentanyl; D004837:Epinephrine