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Indian Journal of Anesthesia and Analgesia

Volume  9, Issue 3, May-june 2022, Pages 149-151

 

Case Report

Anesthetic Management of Dilated Cardiomyopathy for Cesarean Section
Paidmuddala Yashwanth1, Vishnuvardhan V2, Sravanthi GNS3, Ravi Madhusudhana
1Junior Resident, 2Associate Professor, 3Senior Resident, 4Professor & HOD, Department of Anesthesiology, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka,
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http://dx.doi.org/10.21088/ijaa.2349.8471.9322.16

Abstract

Introduction:Dilated cardiomyopathy(DCM) is one of the most common types of non ischemic heart muscle disease among the adult population, and it is associated with a high perioperative mortality. Case Report: A 33-year-old female, G2P1L1+1 at 37 weeks of gestation admitted electively for cesarean section who is a known case of DCM with an ejection fraction of 40%. In the preoperative evaluation, patient has a history of shortness of breath on mild to moderate physical exercise, 12-lead electrocardiography (ECG) showed sinus rhythm with occasional premature ventricular complexes and other parameters are normal. Echocardiogram (Echo) showed severely dilated left ventricle with moderately to severely reduced systolic function due to global hypokinesia and indeterminate filling pressures, and no thrombi were present. All monitoring parameters were connected and an awake arterial line was inserted first followed by epidural in the sitting position. Inj. bupivacaine 0.25% 20 mL + 40 μgn fentanyl was given into the epidural space. The depth of the epidural space was 9.5 cm, while the depth of the catheter was 5.5 cm. The epidural was uneventful, and we changed the patient position into a supine position. Intravenous fluids were maintained at 60–80 mL/h. Intra operative vitals are stable and baby was extracted and blood loss around 700ml.Patient shifted to ICU for close monitoring. Conclusion: Dilated cardiomyopathy is associated with high mortality and persistewnt decrease in quality of mother. Careful selection of drugs and best anesthetic techniques is important for good maternal and fetal outcome.


Corresponding Author : Vishnuvardhan V