| Anestesia epidural combinada y bloqueo de nervios periféricos guiado con ultrasonido para revisión de la herida en una paciente con cardiomiopatía periparto |
Combined epidural anesthesia and ultrasound guided peripheral nerve block for wound revision in a patient with peripartum cardiomyopathy -A case report-.
Gong TK, Kim SS.
Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea.
Korean J Anesthesiol. 2010 Nov;59(5):353-8. doi: 10.4097/kjae.2010.59.5.353. Epub 2010 Nov 25.
Abstract
Peripartum cardiomyopathy (PPCM) is a rare complication that occurs between the late stage of pregnancy and six months after delivery. PPCM presents as symptoms of left ventricular dysfunction and it can be fatal unless treated promptly. Furthermore, anesthesia and surgery in such patients is a large challenge to anesthesiologists. First and foremost, the maintenance of stable hemodynamics is a major concern. We report a case of combined lumbar epidural anesthesia and both ilioinguinal and iliohypogastric nerve block under ultrasound guided for a wound revision in a 37-year-old woman diagnosed with PPCM after an emergency cesarean section.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998658/pdf/kjae-59-353.pdf
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| Informe de caso y mini revisión de literatura: manejo anestésico de cardiomiopatía periparto complicada con pre-eclampsia usando sufentanil en anestesia combinada peridural-espinal |
Case report and mini literature review: anesthetic management for severe peripartum cardiomyopathy complicated with preeclampsia using sufetanil in combined spinal epidural anesthesia.
Bhakta P, Mishra P, Bakshi A, Langer V.
Department of Anesthesiology, Sultan Quaboos University Hospital, Muscat, Sultanate of Oman.
Yonsei Med J. 2011 Jan;52(1):1-12. doi: 10.3349/ymj.2011.52.1.1.
Abstract
Peripartum cardiomyopathy (PPCM) is a rare entity, and anesthetic management for cesarean section of a patient with this condition can be challenging. We hereby present the anesthetic management of a patient with PPCM complicated with preeclampsia scheduled for cesarean section, along with a mini review of literature. A 24 year-old primigravida with twin gestation was admitted to our hospital with severe PPCM and preeclampsia for peripartum care, which finally required a cesarean section. Preoperative optimization was done according to the goal of managing left ventricular failure. Combined spinal epidural (CSE) anaesthesia with bupivacaine and sufentanil was used for cesarean section under optimal monitoring. The surgery was completed without event or complication. Postoperative pain relief was adequate and patient required only one epidural top up with sufentanil 6 hours after operation. To the best of our knowledge there is no report in literature of the use of sufentanil as a neuraxial opioid in the anesthetic management of cesarean section in a patient with PPCM. CSE with sufentanil may be a safer and more effective alternative in such cases.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017683/pdf/ymj-52-1.pdf
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| Dosis baja de anestesia espinal en cardiomiopatía periparto |
Low dose spinal anesthesia for peripartum cardiomyopathy.
Gupta K, Gupta SP, Jose S, Balachander H.
Department of Anesthesia and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
J Anaesthesiol Clin Pharmacol. 2011 Oct;27(4):567-8. doi: 10.4103/0970-9185.86615.
Peripartum cardiomyopathy is a dilated cardiomyopathy associated with cardiac failure in the last month of pregnancy or within five months of delivery. There is no identifiable cause of cardiac failure, no heart disease prior to the last month of pregnancy, and left ventricular systolic dysfunction. It has an incidence of one per 3500 live births and is associated with a high mortality rate (30-60%). Patients present with breathlessness, chest pain, pedal edema, cardiomegaly, and elevated jugular venous pressure (JVP). Complications like atrial/ventricular arrhythmias, congestive heart failure, pulmonary emboli, and even sudden death can occur. There is a strong association with gestational hypertension and twin pregnancies. The rate of Cesarean delivery increases. Many patients with left ventricular dysfunction become normal after delivery. There is a potential detrimental effect of subsequent pregnancy on the outcome of these patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214576/
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| Miocardiopatía periparto y edema agudo pulmonar |
Luis Razzeto-Ríos, Luis Diego Razzeto-Rubio
Rev Per Ginecol Obstet. 2009;55:211-214.
Resumen
Una mujer de 31 años, en la semana 34 de su segunda gestación, ingresó por dolor abdominal difuso de instauración brusca. En la exploración se objetivó una dilatación del cuello uterino de 7 cm, presentación transversa del feto, por lo que se indicó cesárea urgente, que se realizó bajo anestesia subaracnoidea, sin incidencias. Al segundo día del postoperatorio, la paciente inició un cuadro compatible con edema agudo del pulmón. Se le realizó una ecocardiografía, que mostró una disfunción sistólica global del ventrículo izquierdo, con fracción de eyección de 32%, y se diagnosticó miocardiopatía periparto, con insuficiencia respiratoria aguda por insuficiencia cardíaca. Se trató con furosemida y captopril y la evolución fue favorable. Al alta hospitalaria, la ecocardiografía mostró un ventrículo izquierdo de tamaño y espesor normal y fracción de eyección de 50%. La miocardiopatía periparto es una forma de insuficiencia cardíaca que se produce en el último trimestre de embarazo o durante los seis primeros meses del puerperio, en ausencia de una causa demostrable de disfunción ventricular y de enfermedad cardíaca previa. De acuerdo con la presentación clínica y con los hallazgos ecocardiográficos encontrados en esta paciente, consideramos que la miocardiopatía periparto fue la causa del edema agudo de pulmón. Se comunica el primer caso en el Perú.
Palabras clave: Miocardiopatía periparto, edema agudo pulmonar
http://sisbib.unmsm.edu.pe/bvrevistas/ginecologia/vol55_n3/pdf/A12V55N3
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