Frost Don A, Dolak James A
Department of General Anesthesiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, E-31, Cleveland, Ohio 44195, USA.
Can J Anaesth. 2006 May;53(5):478-81. doi: 10.1007/BF03022620.
To describe the impact of maternal automatic implantable cardioverter-defibrillator (AICD) therapy on pregnancy outcome, and discuss the clinical rationale for regional anesthesia in parturients with AICDs.
A 20-yr-old primigravida with a history of familial cardiomyopathy and AICD placement presented at 39 weeks gestational age for elective labour induction. Ultimately, the patient underwent a Cesarean section for a failed induction. Her AICD was deactivated during the peripartum period, although the pacing function remained active as she had an underlying heart rhythm of less than 34 beat.min(-1). The patient had continuous electrocardiogram monitoring via an external defibrillating unit to which she remained connected by external defibrillator pads. Labour analgesia and surgical anesthesia were provided with a lumbar epidural dosed with varying concentrations of bupivacaine. This management resulted in an excellent maternal and fetal outcome.
Automatic implantable cardioverter-defibrillators are being utilized more frequently in the obstetric population, and appear compatible with good fetal outcomes. Experience with the anesthetic management of these patients is markedly limited - primarily involving reports of general anesthesia for Cesarean section. Epidural anesthesia, however, offers distinct advantages in this patient population including easy conversion from labour analgesia to surgical anesthesia, preservation of fetal-maternal hemodynamics, prevention of increases in plasma catecholamines due to labour or operative pain, and, finally, possible direct suppression of arrhythmias by pharmacologically-active plasma levels of local anesthetic.
描述孕产妇自动植入式心脏复律除颤器（AICD）治疗对妊娠结局的影响，并讨论AICD产妇区域麻醉的临床依据。
一名20岁初产妇，有家族性心肌病病史且已植入AICD，孕39周时因择期引产就诊。最终，患者因引产失败接受剖宫产。围产期停用了她的AICD，不过由于其基础心律低于34次/分钟，起搏功能仍保持激活状态。患者通过外部除颤仪进行连续心电图监测，她身上一直贴着外部除颤电极片。采用不同浓度布比卡因进行腰段硬膜外麻醉以提供分娩镇痛和手术麻醉。这种管理方式取得了良好的母婴结局。
自动植入式心脏复律除颤器在产科人群中的使用越来越频繁，且似乎与良好的胎儿结局相符。对这些患者进行麻醉管理的经验明显有限——主要是剖宫产全身麻醉的报告。然而，硬膜外麻醉在这类患者中具有明显优势，包括易于从分娩镇痛转换为手术麻醉、维持母婴血流动力学稳定、预防因分娩或手术疼痛导致血浆儿茶酚胺增加，以及最终可能通过局部麻醉药具有药理活性的血浆水平直接抑制心律失常。
