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Canadian Journal of Anesthesia, Vol 32, 244-247, Copyright © 1985 by Canadian Anesthesiologists' Society

Clinical Reports: Anaesthesia for Caesarean Section in a Pre-Eclamptic Patient with Ebstein'S Anomaly

STEPHEN HALPERN MD FRCP(C)1, ASHOK GIDWANEY MBBS1, and BRONWEN GATES MD FRCP(C)1

1 Department of Anaesthesia, Women's College Hospital, Toronto, Ontario

Address correspondence to: Dr. S. Halpern, Department of Anaesthesia, Women's College Hospital, 76 Grenville Street, Toronto M5S 1B2.

Anaesthetic management for Caesarean section in a pre-eclamptic patient with Ebstein's anomaly and a right to left intracardiac shunt was accomplished under general anaesthesia. Air bubbles in the venous line were meticulously eliminated to prevent paradoxical air emboli. A rapid sequence induction using standard doses of thiopentone and succinylcholine did not result in loss of consciousness and muscle relaxation was inadequate for endotracheal intubation. This problem must be anticipated in patients with exremely enlarged right atria and the dose of induction agents should be increased. Carefully controlled epidural anaesthesia may be used if the cardiac reserve is adequate.

Key Words: ANAESTHESIA: obstetric • GENETIC FACTORS: Ebstein's anomaly • SURGERY: Caesarean section • COMPLICATIONS: pre-eclampsia






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Copyright © 1985 by the Canadian Anesthesiologists' Society.