Combined General and Epidural Anesthesia for Emergency Cesarean Delivery of Twins in a Parturient With Coarctation of Aorta.

Pregnancy is associated with increased coarctation-associated complications. We report the successful management of emergency lower-segment cesarean delivery in a patient with coarctation of aorta. A parturient at 34 weeks of gestation of a twin pregnancy with uncorrected coarctation of aorta was taken for emergency lower-segment cesarean delivery to be performed using epidural anesthesia. A mixture of lignocaine (lidocaine), bupivacaine, and fentanyl was administered epidurally. In view of unsatisfactory motor action, general anesthesia had to be administered. However, because of sufficient analgesia due to the epidural drugs, optimal hemodynamic control was achieved. A combination of general and epidural anesthesia minimizes adverse effects of coarctation of aorta, with improved maternal and fetal outcomes.