A case of uncorrected tetralogy of Fallot with preeclampsia: an anesthetic challenge for cesarean section

Authors

  • Debasish Bhar Midnapore Medical College & Hospital, Midnapore, Paschim Medinipur- 721101
  • Sunanda Maji Midnapore Medical College & Hospital, Midnapore, Paschim Medinipur- 721101
  • Aditi Das Midnapore Medical College & Hospital, Midnapore, Paschim Medinipur- 721101
  • Sudeshna Bhar (Kundu) Institute of Post Graduate Medical Education and Research (IPGMER), 244, Acharya Jagadish Chandra (AJC) Bose Road, Kolkata-700019
  • Ratan Chandra Mandal Midnapore Medical College & Hospital, Midnapore, Paschim Medinipur- 721101

DOI:

https://doi.org/10.3126/jsan.v3i1.14588

Keywords:

Anesthesia, preeclampsia, pregnancy, cesarean section, tetralogy of Fallot

Abstract

Women with cardiovascular diseases may present for cesarean delivery. We present a case of anesthetic management for cesarean section in a patient with uncorrected tetralogy of Fallot complicated with preeclampsia. No definite guideline or information is available in the textbook or literature about the management of such a case. A 21 year primigravida was admitted in our institute with breathlessness on normal day to day life activity. Her blood pressure was 160/100 mmHg, oxygen saturation 85-86% in room air and she had ejection systolic murmur of grade three intensity along the left sternal border. Her echocardiography which was done in the first trimester revealed tetralogy of Fallot with moderate to severe right ventricular outlet obstruction with hypoplastic pulmonary artery and pulmonary valve. Proteinurea was detected on bedside urine examination. The patient was posted for emergency cesarean section due to non-reassuring fetal heart rate associated with preeclamsia. Magnesium sulfate 10 gm intramuscularly was given for seizure prophylaxis and general anesthesia was administered using etomidate as induction agent. The objective of anesthetic management mainly depends on maintaining of systemic vascular resistance and decreasing pulmonary vascular resistance. In preeclampsia systemic vascular resistance is already elevated. Thus treatment of preeclampsia may worsen cyanosis, so we avoided labetalol to reduce blood pressure. Intra-operative and post-operative periods were uneventful and baby had good apgar scores. So we can conclude that cesarean section in patient with both tetralogy of Fallot and preeclampsia can be managed successfully with general anesthesia using techniques which maintain systemic vascular resistance.

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Author Biographies

Debasish Bhar, Midnapore Medical College & Hospital, Midnapore, Paschim Medinipur- 721101

Assistant Professor, Department of Anesthesiology, West Bengal Medical Education Service

Sunanda Maji, Midnapore Medical College & Hospital, Midnapore, Paschim Medinipur- 721101

Assistant Professor, Department of Anaesthesiology

Aditi Das, Midnapore Medical College & Hospital, Midnapore, Paschim Medinipur- 721101

Post graduate trainee, Department of Anaesthesiology

Sudeshna Bhar (Kundu), Institute of Post Graduate Medical Education and Research (IPGMER), 244, Acharya Jagadish Chandra (AJC) Bose Road, Kolkata-700019

Assistant Professor, Department of Anesthesiology

Ratan Chandra Mandal, Midnapore Medical College & Hospital, Midnapore, Paschim Medinipur- 721101

Associate Professor, Department of Obstetrics and Gynaecology

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Published

2016-03-20

How to Cite

Bhar, D., Maji, S., Das, A., Bhar (Kundu), S., & Mandal, R. C. (2016). A case of uncorrected tetralogy of Fallot with preeclampsia: an anesthetic challenge for cesarean section. Journal of Society of Anesthesiologists of Nepal, 3(1), 35–37. https://doi.org/10.3126/jsan.v3i1.14588

Issue

Section

Case Reports