Hussey Patrick T, Hussey Hanna, Egbaria Jamal, Landau Ruth, Townsley Matthew M
From the Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Anesthesiology, Columbia University College of Physicians & Surgeons, New York, New York.
A A Pract. 2023 Apr 11;17(4):e01675. doi: 10.1213/XAA.0000000000001675. eCollection 2023 Apr 1.
Neuraxial anesthesia is preferred over general anesthesia in obstetric patients to avoid airway manipulation, aspiration, and maternal-fetal transfer of medications; however, a sudden sympathetic block is generally avoided in patients with hypertrophic obstructive cardiomyopathy (HOCM). The case of a 31-year-old G2P0010 with HOCM with severe resting left ventricular outflow tract (LVOT) obstruction and systolic anterior motion of the mitral valve undergoing a cerclage under choroprocaine spinal anesthesia is presented. Risks and benefits of general versus neuraxial anesthesia, and epidural versus spinal anesthesia, in this specific setting are reviewed.
在产科患者中，与全身麻醉相比，神经轴索麻醉更受青睐，以避免气道操作、误吸以及药物的母胎转运；然而，肥厚型梗阻性心肌病（HOCM）患者通常应避免突然发生的交感神经阻滞。本文介绍了一名31岁、孕2产0010、患有HOCM且存在严重静息性左心室流出道（LVOT）梗阻及二尖瓣收缩期前向运动的患者，在氯普鲁卡因脊髓麻醉下接受宫颈环扎术的病例。本文还回顾了在这一特定情况下全身麻醉与神经轴索麻醉、硬膜外麻醉与脊髓麻醉的风险和益处。
