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Canadian Journal of Anesthesia 48:681-683 (2001)
© Canadian Anesthesiologists' Society, 2001
Obstetrical and Pediatric Anesthesia

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

[L'anesthésie rachidienne et péridurale combinée pour la césarienne chez une patiente souffrant de cardiomyopathie du péripartum]

Roman Shnaider, MD, Tiberiu Ezri, MD, Peter Szmuk, MD, Stephen Larson, DMD, R. David Warters, MD and Jeffrey Katz, MD

From the Department of Anesthesiology University of Texas Medical School at Houston, Houston, Texas, USA.

Address correspondence to: Dr. Peter Szmuk, Assistant Professor, The University of Texas-Houston Medical School, Department of Anesthesiology, 6431 Fannin, MSB 5.020 Houston, Texas 77030, USA. Phone: 713-500-6184; Fax: 713-500-6201; E-mail: Peter.Szmuk{at}uth.tmc.edu

Purpose: To report a case of peripartum dilated cardiomyopathy associated with morbid obesity and possible difficult airway presenting for elective Cesarean section, which was successfully managed with combined spinal-epidural anesthesia.

Clinical features: A morbidly obese parturient with a potentially difficult airway, suffering from idiopathic peripartum cardiomyopathy (ejection fraction 20%), was scheduled for an elective Cesarean section.

A combined spinal epidural anesthesia was performed and 6 mg of bupivacaine were injected into the subarachnoid space. This was supplemented after 60 min with 25 mg of bupivacaine injected epidurally. The patient's hemodynamic status was monitored with direct intra-arterial blood pressure and central venous pressure measurements. The patient's perioperative course was uneventful.

Conclusion: In patients suffering from peripartum cardiomyopathy, undergoing Cesarean section, combined spinal-epidural anesthesia may be an acceptable anesthetic alternative.




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Copyright © 2001 by the Canadian Anesthesiologists' Society.