Continuous spinal analgesia for labor pain in a parturient with aortic stenosis.
Aortic stenosis in pregnancy carries a high fetal and maternal morbidity and mortality. Spinal analgesia/anesthesia is considered by many to be contraindicated in these patients. The rapid onset of sympathetic block induces hypotension, which can result in myocardial hypoperfusion and myocardial ischemia. We describe a case of moderate to severe aortic stenosis, diagnosed during pregnancy, in which pain relief during labor and delivery was managed using a continuous spinal catheter. Pure intrathecal opioid analgesia was used initially to maintain hemodynamic stability. However after two bolus administrations of sufentanil, analgesia was further maintained using ropivacaine and sufentanil. A spinal catheter was chosen to provide reliable anesthesia, which could be extended rapidly for cesarean section.
Van de Velde
M
M
Department of Anesthesiology, Katholieke Universiteit Leuven, Leuven, Belgium. marc.vandevelde@uz.kuleuven.ac.be
Budts
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W
Vandermeersch
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E
Spitz
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B