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Low dose bupivacaine spinal anesthesia for emergency cesarean section in a patient with uncorrected tetralogy of fallot, presenting with placenta previa

  • Anna Millizia ,


Abstract

Background: Pregnant women with congenital heart disease tetralogy of fallot who undergo cesarean section have their own challenges for the anesthesiologist, not to mention if they have pregnancy complications such as placenta previa. The choice of the safest anesthetic technique is still debated today. The anesthetic technique must be able to maintain systemic vascular resistance, avoid increasing pulmonary vascular resistance, and be aware of the threat of blood loss due to placenta previa.

Case Report: 29 years old pregnant woman, weighing 46 kg and height 155 cm, G1P0A0, Gravida 27-28 weeks, single alive fetus, fetal distress, comes with complaints of shortness of breath, vaginal bleeding due to placenta previa with tetralogy of fallot planned emergency cesarean section. The patient presented with functional class NYHA II-III. We used low-dose spinal anesthesia with 5 mg bupivacaine 0.5% and 25 ug fentanyl as an adjuvant. Colloading was done with gelofusin colloid fluid to replace the amount of bleeding. Hemodynamics prior to anesthesia were BP 120/80, Heart Rate 80 x/minure, SpO2 72% with a non-rebreathing mask 10 litre/minute. There was no severe hypotension during surgery, and was hemodynamically stable with limited use of vasopressors. After the cesarean section was completed, the patient was transferred to the ICU and treated for 2 days, and was only discharged after 5 days of treatment without additional complications.

Conclusion: The use of low-dose spinal anesthesia in combination with adjuvant fentanyl results in a relatively safe anesthetic technique with minimal hemodynamic changes and adequate analgesia for cesarean delivery.

Keywords: tetralogy of fallot pregnancy placenta previa low dose spinal anesthesia

References

  1. Chestnut DH, Polley LS, Tsen LC, Wong CA. Foundations in Obstetric Anesthesia [Internet]. Chestnut’s Obstetric Anesthesia: Principles and Practice. Elsevier; 2009. p. 209–10. Available from: http://dx.doi.org/10.1016/b978-0-323-05541-3.00073-9
  2. Juwarkar C, Bharne SS. Anesthetic management of a parturient with uncorrected tetralogy of Fallot for Cesarean section. Anesth essays Res [Internet]. 2012;6(2):244–6. Available from: https://pubmed.ncbi.nlm.nih.gov/25885631
  3. Baidya D, Dehran M, Dhir R, Mahapatra B. Central neuraxial anesthesia for caesarean section in parturients with uncorrected tetralogy of fallot: Two cases. J Obstet Anaesth Crit Care [Internet]. 2012;2(1):47. Available from: http://dx.doi.org/10.4103/2249-4472.99325
  4. Jain D, Kumar K, Singh A, Punj J. Low Dose Combined Spinal-Epidural Anesthesia: An Anesthesia Technique for Cesarean Section in a Patient Suffering from Congenitally Corrected Transposition of Great Arteries and Severe Pulmonary Stenosis. J Anesthesiol Reanim Spec Soc [Internet]. 2021; Available from: http://dx.doi.org/10.5222/jarss.2021.22448
  5. Hartono R, Rahardjo S, Uyun Y. low Dose Spinal Anesthesia Bupivacaine 0.5% 5 mg with Adjuvant Fentanyl 50 mcg for Patients with Uncorrected Tetralogy of Fallot undergoing Caesarean section. J Anestesi Obstet Indones [Internet]. 2020;2(2):93–9. Available from: http://dx.doi.org/10.47507/obstetri.v2i2.15
  6. Prakash SY, Kartik M, Rao M, Harde YR. Challenges Faced in Managing an Adult Uncorrected Tetralogy of Fallot Patient with Pneumonia and Septic Shock in the Intensive Care Unit. Indian J Crit Care Med [Internet]. 2020 Nov;24(11):1135–6. Available from: https://pubmed.ncbi.nlm.nih.gov/33384524
  7. Adinarayanan S, Parida S, Kavitha J, Balachander H. Spinal anesthetic for emergency cesarean section in a parturient with uncorrected tetralogy of Fallot, presenting with abruptio placentae and gestational hypertension. J Anaesthesiol Clin Pharmacol [Internet]. 2014 Jul;30(3):400–2. Available from: https://pubmed.ncbi.nlm.nih.gov/25190952
  8. Gajbhare MKN, Kamble NP. Comparative Study of Intrathecal Bupivacaine versus Bupivacaine with Fentanyl for Cesarean Section. Indian J Clin Anaesth [Internet]. 2016;3(2):271. Available from: http://dx.doi.org/10.5958/2394-4994.2016.00049.4

How to Cite

Millizia, A. (2022). Low dose bupivacaine spinal anesthesia for emergency cesarean section in a patient with uncorrected tetralogy of fallot, presenting with placenta previa. Bali Medical Journal, 11(3), 1764–1766. https://doi.org/10.15562/bmj.v11i3.3674
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