Tsukinaga Akito, Irie Tomoya, Uchimoto Kazuhiro, Miyashita Tetsuya, Goto Takahisa
Masui. 2016 Oct;65(10):1031-1033.
In a 30-year-old pregnant woman with supravalvular pulmonary stenosis after Jatene operation, the right ventricular and pulmonary artery pressure were 54/4 and 30/10 mmHg respectively in the non-pregnant condition. She was hospitalized due to pregnancy induced hypertension at 37 weeks of gestation. At the end of pregnancy, right ventricular failure occurred due to the increased circulatory plasma volume. Induc- tion of delivery was started at 37 weeks 6 days. How- ever, emergency cesarean section was planned because of maternal fatigue and uterine inertia. It was expected that airway management might be difficult because of obesity and full stomach. We chose combined spinal and epidural anesthesia. To avoid rapid reduction of systemic vascular resistance, we selected 0.5% isobaric bupivacaine 1.9 ml and fentanyl 10 gg for spinal anesthesia. Because inadequate analge- sia might worsen right ventricular failure, we added epidural anesthesia. The loss of cold sensation had reached at the fifth thoracic dermatomal level. The hemodynamics was stable without vasopressors. The continuous infusion of 0.2% ropivacaine from epidural catheter was started immediately after the delivery of the baby. As the result of choosing the appropriate anesthesia method, type and amount of local anesthetic, we succeeded in anesthetic management of this patient with right ventricular failure.
一名30岁的孕妇，曾接受Jatene手术后患有肺动脉瓣上狭窄，非孕期时右心室和肺动脉压力分别为54/4 mmHg和30/10 mmHg。她在妊娠37周时因妊娠高血压住院。妊娠末期，由于循环血浆量增加，发生了右心室衰竭。在妊娠37周6天时开始引产。然而，由于产妇疲劳和宫缩乏力，计划进行急诊剖宫产。预计由于肥胖和胃内容物充盈，气道管理可能会很困难。我们选择了腰麻联合硬膜外麻醉。为避免全身血管阻力迅速降低，腰麻选用0.5%等比重布比卡因1.9 ml和芬太尼10 μg。由于镇痛不足可能会加重右心室衰竭，我们加用了硬膜外麻醉。冷觉消失平面达胸5皮节水平。血流动力学稳定，无需使用血管升压药。婴儿娩出后立即开始经硬膜外导管持续输注0.2%罗哌卡因。由于选择了合适的麻醉方法、局麻药类型和用量，我们成功地对这名右心室衰竭患者进行了麻醉管理。
