title: High-Dose Desflurane for Tocolysis During Intrapartum Myelomeningocele Repair in a Patient With Post-Adriamycin Cardiomyopathy.
abstract: High-dose desflurane is an uncommon need during general anesthesia. At our institution, open fetal surgery cases are managed with high desflurane concentrations to ensure uterine relaxation. We present a case of a 32-year-old parturient with a history of mild cardiomyopathy undergoing open fetal myelomeningocele repair. Phenylephrine and dopamine infusions helped maintain hemodynamic stability at 18% desflurane, while cardiac function was monitored with transthoracic echocardiography. This case is notable for the unknown risk of using high-dose desflurane with a preexisting cardiomyopathy and raises the question of the acceptable maternal risk in the setting of fetal surgery.
authors.affiliation: From the Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Ho
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Feldman
mesh_terms: D000328:Adult; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000000981:diagnostic imaging; D000077335:Desflurane; D004317:Doxorubicin / Q000009:adverse effects*; D005260:Female; D005332:Fetoscopy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008591:Meningomyelocele / Q000000981:diagnostic imaging / Q000601:surgery*; D011247:Pregnancy; D015145:Tocolysis / Q000379:methods*
chemical_list: D018685:Anesthetics, Inhalation; D004317:Doxorubicin; D000077335:Desflurane; D007530:Isoflurane