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Indian Journal of Anesthesia and Analgesia 11(4):p 243-245, Oct - Dec. 2024. | DOI: 10.21088/ijaa.2349.8471.11424.14
Case Report
Anaesthetic Management of a Case of Pregnancy with Rheumatic Heart Disease with Active Varicella Presenting for Caesarean Section
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Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
Indian Journal of Anesthesia and Analgesia 11(4):p 243-245, Oct - Dec. 2024. | DOI: 10.21088/ijaa.2349.8471.11424.14
How Cite This Article:
Ratan N, Kiran N. Anaesthetic management of a case of pregnancy with rheumatic heart disease with active varicella presenting for caesarean section. Ind J Anesth Analg. 2024;11(4):243-5.Timeline
Received : September 13, 2024
Accepted : October 16, 2024
Published : December 20, 2024
Abstract
Introduction: The varicella zoster virus (VZV), a DNA virus in the herpes family, causes chickenpox, a generally mild but contagious illness. About 5–10% of pregnant women lack VZV antibodies and can contract varicella during pregnancy. The impact of primary VZV infection varies with the gestational period: maternal complications are highest in the third trimester, while fetal risks are greatest in the first and second trimesters. Mitral stenosis from rheumatic fever is the most common valvular heart disease in pregnancy, usually emerging due to cardiovascular changes. Improved care has reduced related mortality and morbidity. Case Report: A 25-year-old female diagnosed with G2P1L1 with 36 weeks 4 days gestation with active varicella infection with rheumatic heart disease in latent labour, posted for emergency LSCS. Thorough pre-anaesthetic evaluation was done to assess patient’s ability to respond to physiological challenges encountered intraoperatively. Patient presented to the hospital with complaints of breathlessness and active varicella infection for 2 days. Patient had not been diagnosed with any other co-morbidities prior to this. In view of breathlessness, ECG, chest X-ray and 2D echo was done and patient was found to have RHD with sever MS, sever TR, sever PAH with preserved EF of 60%. General anaesthesia was performed and patient was induced with thiopentone and fentanyl, patient was intubated with endotracheal tube, maintained with isoflurane, vecuronium. Patient was started on inj. Furosemide 0.5ml/hr intra op. Blood gas analyses done intraoperatively to correct metabolic, electrolyte disturbances, blood sugars monitored for glycemic control, adequate volume replacement was done with crystalloids. Post-operatively patient was shifted to ICU with endotracheal tube for postoperative elective ventilation, extubated the following day. Conclusion: Numerous hemodynamic factors must be evaluated to determine the suitable anaesthesia for caesarean section in sever RHD patients. Both regional and general anaesthesia have been administered for caesarean sections in parturients with varicella. When selecting anaesthesia technique, its essential to thoroughly weigh the risk and benefits of general anaesthesia and central neuraxial block.
References
- 1. Nataraj MS, Giri V. Anesthetic management of cesarean section with mitral stenosis and respiratory tract infection. J Obstet Anaesth Crit Care 2014;4:78-80.
- 2. Bansal UV et al. Int J Reprod Contracept Obstet Gynecol. 2020 Nov;9(11):4759-4761.
- 3. Ohri R, Vyas V. Anesthetic Implications in a Primigravida Posted for Cesarean Section with Varicella Zoster Infection. J South Asian Feder Obst Gynae 2018;10(4):291-292.
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Funding
This research received no funding.
Author Contributions
All authors contributed significantly to the work and approve its publication.
Ethics Declaration
This article does not involve any human or animal subjects, and therefore does not require ethics approval.
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Conflicts of Interest
The authors report no conflicts of interest in this work.
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Cite this article
Ratan N, Kiran N. Anaesthetic management of a case of pregnancy with rheumatic heart disease with active varicella presenting for caesarean section. Ind J Anesth Analg. 2024;11(4):243-5.
Licence:
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
| Received | Accepted | Published |
|---|---|---|
| September 13, 2024 | October 16, 2024 | December 20, 2024 |
DOI: 10.21088/ijaa.2349.8471.11424.14
Keywords
General anaesthesiaCaesarean sectionVaricella zosterMitral stenosisRHDSearch for Similar Articles
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Timeline
| Received | September 13, 2024 |
| Accepted | October 16, 2024 |
| Published | December 20, 2024 |
licence
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
