[Combined spinal-epidural anesthesia for cesarean section in a patient with dilated cardiomyopathy].
We report successful anesthetic management of elective cesarean section in a 31-year-old patient with dilated cardiomyopathy (DCM) using combined spinal-epidural anesthesia (CSEA). After inserting an arterial catheter and central venous catheter, isobaric bupivacaine (0.5% ; 5 mg) with fentanyl 10 microg was injected intrathecally at the L4-5 interspace under administration of dopamine 3 microg kg(-1) min(-1). 10 min and later, a total of ropivacaine (0.5%; 70 mg) with fentanyl 50 microg was titrated at 2-3 min intervals through the epidural catheter inserted at the L1-2 interspace resulting in analgesic level of T4 25 min after induction of spinal anesthesia. A baby was delivered uneventfully with good Apgar score, and the patient's perioperative hemodynamic change was minimal. CSEA is a reliable, titratable technique, which provides excellent analgesia with minimal hemodynamic changes for patients with DCM undergoing cesarean section.
Toda
Narushi
N
Department of Anesthesia, Kagawa Rosai Hospital, Marugame, Japan.
Maeda
Kazushige
K
Shoji
Emiko
E
Suzuki
Tsutomu
T
Kitaura
Michio
M
Nishimoto
Masahiko
M
D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D002311:Cardiomyopathy, Dilated; D002585:Cesarean Section; D005260:Female; D006801:Humans; D019990:Perioperative Care; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular