Department of Anesthesiology, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
Department of Anesthesiology, Isesaki Municipal Hospital, 12-1 Tsunatorihonmachi, Isesaki, Gunma, 372-0817, Japan.
J Med Case Rep. 2024 Aug 5;18(1):355. doi: 10.1186/s13256-024-04694-x.
Pregnancy in a woman with heart and chronic renal failure can lead to life-threatening complications for both mother and child. Although such cases are often delivered by cesarean section, few reports have described anesthesia methods.
We encountered a case in which cesarean section was performed using combined spinal and epidural anesthesia for a pregnant woman with chronic renal and heart failure. The 35-year-old Japanese woman had been undergoing hemodialysis for several years. Heart failure symptoms that appeared during pregnancy initially improved with treatments such as increasing hemodialysis, but recurred. She was admitted to the intensive care unit. The initial plan was to deliver the baby after a few weeks, but further progression of heart failure became a concern. After a clinical conference among staff, a cesarean section with combined spinal and epidural anesthesia was scheduled for 24 weeks, 0 days of gestation. The anticoagulant for dialysis was also changed from heparin to nafamostat in preparation for cesarean section. Monitoring was started with central venous and radial artery pressures before induction of anesthesia. Combined spinal and epidural anesthesia was induced and the cesarean section was completed without complications. Surgery was initiated under continuous administration of phenylephrine, which was intended to avoid hypotension due to anesthesia. The hemodynamic and respiratory status of the patient remained stable postoperatively. After the cesarean section, morphine was administered epidurally and the epidural catheter was removed.
Cesarean section was safely performed for a pregnant woman with renal and heart failure using combined spinal and epidural anesthesia.
患有心脏和慢性肾衰竭的女性怀孕可能会给母婴带来危及生命的并发症。尽管此类病例通常采用剖宫产分娩，但很少有报道描述麻醉方法。
我们遇到了一位慢性肾和心力衰竭孕妇行剖宫产采用腰硬联合麻醉的病例。这位 35 岁的日本女性已经接受了多年的血液透析。妊娠期间出现的心力衰竭症状最初通过增加血液透析等治疗得到改善，但随后又复发。她被收入重症监护病房。最初的计划是在几周后分娩，但心力衰竭进一步恶化令人担忧。在医务人员进行临床会诊后，计划在 24 周零 0 天妊娠时行腰硬联合麻醉剖宫产。为了准备剖宫产，透析用抗凝剂也从肝素改为那屈肝素。在诱导麻醉前开始监测中心静脉压和桡动脉压。诱导腰硬联合麻醉，顺利完成剖宫产术，无并发症发生。手术开始时持续给予去氧肾上腺素，以避免因麻醉引起的低血压。患者术后血流动力学和呼吸状况保持稳定。剖宫产术后硬膜外给予吗啡，并拔除硬膜外导管。
对于患有肾和心力衰竭的孕妇，采用腰硬联合麻醉行剖宫产是安全的。
