Epidural anaesthesia during labour for a patient with congenital complete heart block: a case report.
We report labour pain management in a full-term pregnant patient with Congenital Complete Heart Block. She delivered uneventfully under routine monitoring with facilities for pacing at hand. She previously had an uneventful normal delivery and a D&E, both outside our hospital. Only findings were a low heart rate of 45-50 beats per minute. She never had syncopal attacks. She had a good effort tolerance on ETT. Her ejection fraction was 60% on Echocardiogram. She was given a single shot low dose spinal with fentanyl followed by epidural insertion. She successfully delivered through mid-cavity forceps in about 2.5 hours. The only problem encountered was a transient bradycardia of 40 per minute with a systolic blood pressure of 70 mmHg, which settled with ephedrine. Pace maker insertion is recommended early in case the patient is symptomatic or has a prolonged Q-T interval or left atrial enlargement on ECG. Regional anaesthesia is recommended to prevent valsalva induced bradycardia or cardiac arrest during expulsive efforts by the patient.
Department of Anaesthesiology Aga Khan University, Karachi.
Abdul
A
Monem
Ursula
U
Chohan
Mohammed
M
Ali
D000328:Adult; D000767:Anesthesia, Epidural; D054537:Atrioventricular Block / Q000209:etiology / Q000503:physiopathology*; D002302:Cardiac Output; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D011247:Pregnancy