Graded Epidural Anaesthesia for Caesarean Section in a Parturient With Severe Left Ventricular Dysfunction From Dilated Cardiomyopathy: A Case Report
DOI:
https://doi.org/10.60787/njgp.v15i1.115Keywords:
severe left ventricular dysfunction, graded epidural anaesthesia, Dilated cardiomyopathyAbstract
Dilated cardiomyopathy (DCM) is a primary disorder of heart muscle characterised by left ventricular (LV) or biventricular dilatation and
impaired ventricular contractility. During pregnancy, women with DCM have a higher incidence of cardiac events than the non-pregnant
patient. When DCM is associated with severe LV dysfunction, anaesthetic management is particularly challenging, because severe LV
dysfunction is a predictor of sudden cardiac death and poor quality of life. The goals of anaesthetic management in DCM consist of
maintaining normovolaemia, and avoiding myocardial depression and drug overdose during induction (as circulation time is slow). It also
includes preventing increases in ventricular afterload and sudden hypotension when regional anaesthesia is a choice. This case report describes the successful anaesthetic management of a parturient with DCM and a severely low LV ejection fraction of 20%, wherein the child was delivered via caesarean section using a graded epidural anaesthesia technique.
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