title: Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report.
abstract: Postural orthostatic tachycardia syndrome encompasses a group of disorders characterized by orthostatic intolerance. We describe the anaesthetic management of analgesia for labour and of Caesarean section in a parturient suffering from this disorder. Worsening of her symptoms during pregnancy was managed with an increase in the dose of beta-blockers taken by the patient. Epidural analgesia was instigated early to attenuate the stress of labour and avoid consequent triggering of a tachycardic response. Slow titration of epidural analgesia and anaesthesia after an adequate fluid preload was undertaken to minimize hypotension and subsequent tachycardia. Neuraxial opioid, combined with non-steroidal anti-inflammatory drugs and bilateral iliohypogastric and ilioinguinal nerve blocks were used to optimize postoperative analgesia.
authors.affiliation: Department of Anaesthesiology, Box 3094, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: W L
authors.initials: WL
authors.lastname: Corbett
authors.forename: C M
authors.initials: CM
authors.lastname: Reiter
authors.forename: J R
authors.initials: JR
authors.lastname: Schultz
authors.forename: R J
authors.initials: RJ
authors.lastname: Kanter
authors.forename: A S
authors.initials: AS
authors.lastname: Habib
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods; D000767:Anesthesia, Epidural / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods*; D002585:Cesarean Section / Q000379:methods; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000628:therapy; D011183:Postoperative Complications / Q000628:therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology / Q000628:therapy*; D011256:Pregnancy Outcome; D013577:Syndrome; D013610:Tachycardia / Q000503:physiopathology / Q000628:therapy*