MR

1. RESEARCH POSTER PRESENTATION DESIGN © 2012
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RESEARCH POSTER PRESENTATION DESIGN © 2019
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Peripartum cardiomyopathy is a unique cardiomyopathy of
unknown cause that occurs during late pregnancy or
postpartum period with mortality of 30 to 60% and poses
anaesthetic challenge.
INTRODUCTION
CASE REPORT
ANAESTHETIC MANAGEMENT:
PRE OP EVENTS:
Patient assessed for Emergency LSCS Under ASA IIIE
High risk informed Consent obtained
PATIENT PLANNED FOR COMBINED EPIDURAL AND SPINAL ANAESTHESIA:
INTRA OP EVENTS:
● Pt taken for surgery under combined spinal epidural anaesthesia
● Pt shifted to OT and connected to monitors
● Two peripheral I.V.lines secured
● With patient in right lateral position,at level L2-L3 epidural catheter inserted and fixed at 10cms
using 18G Tuohy’s needle(LOR technique).Test dose given with 1.5%lignocaine 3ml with 15mcg
adrenaline
● Subarachnoid block given with 1cc of 0.5%hyperbaric bupivacaine at L3-L4 level
● Followed by which epidural volume expansion done by injecting 10ml of saline in the epidural space
● Patient placed in supine position and wedge kept under the right hip
● Level of blockade-T6
● Baby delivered with APGAR 8/10,followed by which Inj.Oxytocin 10IU I.V.infusion & 10I.U.
I.M.given.Inj.Frusemide 20mg I.V.stat given
● Fluids:500ml of crystalloids given
● Intra-op vitals stable and uneventful
INTRA OP VITALS:PR-84-97/min , BP-100/60-120/80 mm HG
SPO2-99-100% , RR-16-18/min
POST OP EVENTS:
● Patient shifted to labour ICU for observation
● Post op analgesia given for 2 days by epidural
top-up with 0.25%bupivacaine 6ml with
50mcg of fentanyl twice daily
● Post-op period uneventful
ANAESTHETIC GOALS:
● Reduce the amount of volume returning to the heart(preload reduction)
● Decrease the resistance against which heart must pump(after load reduction)
● Increase the contractile force of the heart(ionotropy)
● Maintain uteroplacental blood flow
PPCM is a rare form of dilated cardiomyopathy associated with pregnancy.Criteria
for PPCM includes
TRADITIONAL CRITERIA:
● Onset of heart failure during the last month of pregnancy or within 5 months
of delivery
● No other identifiable cause of heart failure
● No known heart disease before pregnancy
ECHOCARDIOGRAPHIC CRITERIA:
● Left ventricular ejection fraction<45%
● Fractional shortening<30%
● Left ventricular end-diastolic volume>27mm/m2
In GA,the stress of laryngoscopy and intubation coupled with the
myocardial depressant effects of anaesthetics are not beneficial for these
patients.Hence regional anaesthesia as an alternative to be considered.These
patients can be managed with CSE technique.This technique avoids stress
response,myocardial suppressant effect of inhaled agents,neonatal
depression and decrease in venous return due to PPV.Controlled hypotension
and adequate level of analgesia can be achieved with low dose spinal
anaesthesia along with either epidural activation or by epidural volume
expansion method.
● Chestnut’s Obstetric Anaesthesia 5th edition-Cardiovascular disease Page
no.989
● Tiwari AK, Agrawal J, Tayal S, Chadha M, Singla A, Valson G, et al. Anaesthetic
management of peripartum cardiomyopathy using "epidural volume
extension" technique: A case series. Ann Card Anaesth 2012;15:44-6.
A 28years old patient with 9 months of
amenorrhea,K/C/O gestational hypertension on treatment
was admitted with complaints of palpitations and dypnoea
on exertion for 3 days.
Patient was started on labetalol infusion and on
T.Frusemide 20mg BD
ON EXAMINATION:
Patient Conscious,Oriented, Afebrile
PR-88/min
BP-140/90mmHg
Spo2-98% in RA
RR-18/min
JVP-not elevated
CVS-S1,S2+ pansystolic murmur MA
RS-B/L NVBS +
INVESTIGATIONS:
Hb – 10.4g/dl ,
Platelets – 1.4 lakhs/cumm,
RBS-86mg/dl, RFT-WNL,LFT-WNL
Sodium – 140meq/L , Pottasium- 3.8 meq/L,
ECG – Normal Sinus Rhythm
ECHOCARDIOGRAPHY:
Mild Global Hypokinesia of LV
Mild LVSD
Mild-Mod MR
No AS/AR,No PAH
EF-38%
Imp:PPCM
AUTHOR:DR.DEEPAK/CO–AUTHORS: Assistant Professor-DR.CHITHRALEKHA M.D.
DEPARTMENT OF ANAESTHESIOLOGY,KAPV GOVERNMENT MEDICAL COLLEGE,TRICHY
MANAGEMENT OF PERIPARTUM CARDIOMYOPATHY UNDER REGIONAL ANAESTHESIA POSTED FOR LSCS
DISCUSSION:
REFERENCES:
Regional anaesthesia is a safe alternative in the
management of peripartum cardiomyopathy patients posted
for LSCS.
CONCLUSION