Tanaka Nobuhiro, Fujii Tomoaki, Mikami Niina, Uchinami Yuka, Saito Hitoshi, Morimoto Yuji
Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
JA Clin Rep. 2019 May 7;5(1):31. doi: 10.1186/s40981-019-0251-0.
Although rare, long-lasting fetal tachyarrhythmia often leads to fetal heart failure and hydrops. Some mothers receive transplacental treatment of fetal tachyarrhythmia (TTFT), which can potentially worsen maternal hypotension and bradycardia. Moreover, the use of rescue cardiovascular agents intraoperatively can worsen fetal tachycardia. However, reports of the anesthetic management of patients receiving TTFT are rare.
A 31-year-old woman who was receiving digoxin and sotalol for TTFT underwent planned elective cesarean section. The fetus had hypoplastic left heart syndrome, hydrops, and tachycardia. We used combined spinal-epidural anesthesia with a reduced dose of local anesthetic. We also employed a non-invasive continuous hemodynamic monitoring system. The mother's systolic blood pressure remained at ≥ 90% of the baseline value; intraoperative administration of rescue cardiovascular agents was not required.
We successfully anesthetized a woman for cesarean section, who was receiving TTFT for fetal tachyarrhythmia, using combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring.
尽管罕见，但持续性胎儿心动过速常导致胎儿心力衰竭和水肿。一些母亲接受胎儿心动过速的经胎盘治疗（TTFT），这可能会加重母亲的低血压和心动过缓。此外，术中使用抢救性心血管药物会加重胎儿心动过速。然而，关于接受TTFT治疗的患者麻醉管理的报道很少。
一名31岁接受地高辛和索他洛尔进行TTFT治疗的女性接受了择期剖宫产手术。胎儿患有左心发育不全综合征、水肿和心动过速。我们采用了减少局部麻醉药剂量的腰麻-硬膜外联合麻醉。我们还使用了无创连续血流动力学监测系统。母亲的收缩压维持在基线值的≥90%；术中无需使用抢救性心血管药物。
我们成功地为一名因胎儿心动过速接受TTFT治疗的女性进行了剖宫产麻醉，采用了腰麻-硬膜外联合麻醉和无创连续血流动力学监测。
