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Vasodilatation, decrease in the blood pressure and increase in the heart rate: case report A 30-year-old pregnant woman developed vasodilatation following administration of with bupivacaine, chloroprocaine, fentanyl and ropivacaine for anaesthesia and oxytocin to maintain adequate uterine tone during pregnancy. Additionally, she developed decrease in the blood pressure and increase in the heart rate following administration of oxytocin[not all routes stated]. The pregnant woman with Eisenmenger syndrome, presented to the hospital at the 19 weeks of gestation for evaluation of hypoxemia due to Eisenmenger syndrome, and uncorrected ventricular septal defect seen in a previous echocardiogram. She was admitted to the ICU and placed oxygen therapy resulting in improvement in the oxygen saturation. Due to increased pulmonary vascular resistance ratio, she started receiving treprostinil inhalation and oral sildenafil; the treprostinil and sildenafil were titrated to effect. She was then discharged on sildenafil 20mg three times a day, 9 puffs of treprostinil 4 times a day and enoxaparin-sodium 40 mg/day. Additionally, oxygen therapy was also suggested. She was admitted again at 30 weeks of gestation and transitioned from treprostinil to IV epoprostenol via a venous catheter 1 ng/kg/min initially and then increased to 17 ng/kg per minute over a period of 2 weeks. Thereafter, her anticoagulant therapy was switched form enoxaparin-sodium to SC heparin [unfractionated heparin] 7500U twice daily. Heparin was discontinued 2 days before the delivery. Her platelet function test revealed intrinsic platelet dysfunction. She received betamethasone for foetal lung maturation. At 33 weeks of gestation, change in the foetal position from breech to cephalic was noted and labour induction was planned. She underwent placement of a lumbar epidural on the day of induction. Extracorporeal membrane oxygenation, radial arterial catheter and central venous catheter were in place. She received anaesthesia with ropivacaine 0.1% along with fentanyl 2 mg/mL (running at 2 mL/hour). She also required small boluses of 0.25% bupivacaine 2–4mL and slow titration to 8 mL/hour during progression of active labour. Her epidural was pulled back after development of unilateral block. Subsequently, membranes were ruptured artificially to accelerate labour. However, she had umbilical cord prolapse that led to foetal bradycardia. Hence, the cord was reduced and 3% chloroprocaine 7mL was administered immediately. Thereafter, she was shifted to operating room and a recovery of the foetal heart rate was noted. An emergency caesarean section was planned; she additionally received 3% chloroprocaine 15 mL boluses. She delivered a live-born infant and the weight of was 1508g (Apgar scores at 1 and 5 minute were 7 and 7, respectively). After the delivery, her examination showed gradual increase in the hear rate to 150 beats/minute, decrease in the blood pressure and slight decrease in oxygen saturation. She received 40 units of IV oxytocin over 30 minutes to mainta