Combined spinal-epidural anesthesia for cesarean section in a patient with dilated cardiomyopathy
Toda, N.; Maeda, K.; Shoji, E.; Suzuki, T.; Kitaura, M.; Nishimoto, M.
Masui. Japanese Journal of Anesthesiology 57(2): 187-190
2008
ISSN/ISBN: 0021-4892 PMID: 18277568 Document Number: 622629
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.