Anesthetic management of cesarean section in a patient with single atrium and single ventricle after cavo-pulmonary bypass surgery.

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Other Title
  • 両側大動脈‐肺動脈バイパス術（グレン手術）後患者の帝王切開術の麻酔経験

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Description

A 30-year-old femele experienced a successful pregnacy without major complications. In her history, cavo-pulmonary shunt operation and replacement of common AV value was performed in a diagnosis of single ventricle and single atrium seven years ago. It was the first successful case of these operations in the world. She was admitted for disability (NYHA II) at the 27th week of pregnacy, and ceasrean section was scheduled due to heart failure (NYHA III) at the 36th week. General anesthesia was induced with fentanyl and ketamine and maintained with nitrous oxide, oxygen, fentanyl and diazepam. Since she possess no right atrium and ventricle, and pulmoary blood flow was dependent on the pressure difference between central vein and left atrium, we paid several attensions to maintain pulmonary blood flow. The points of this anesthetic management were considered as follows;<br>1) to keep appropriate central venous pressure (20-25torr)2) careful use of anesthetics, muscle relaxants and uterine stimulating drugs, especially which affect hemodynamics, 3) cardiac oscillation ventilation not to increase intrathoracic pressure, 4) to avoid over-infusion or-transfusion, 5) to avoid sudden circullatory collapse (spinal anesthesia may be contraindicated), 6) aorto-caval decompression, 7) to manage sleeping baby, etc. According to these managements, benign course of delivery was obtained.

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Details 詳細情報について

  • CRID
    1390282679735572480
  • NII Article ID
    130003582149
  • DOI
    10.2199/jjsca.6.270
  • ISSN
    13499149
    02854945
  • Text Lang
    ja
  • Data Source
    • JaLC
    • Crossref
    • CiNii Articles
    • OpenAIRE
  • Abstract License Flag
    Disallowed

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