Use of remifentanil in general anesthesia for emergency cesarean section in a patient with severe valvular heart disease and pulmonary hypertension

Wong, Andrew Y. C.
January 2008
Internet Journal of Anesthesiology;2008, Vol. 15 Issue 2, p16
Academic Journal
A 23 year-old, 160 cm, 50 kg, gravida 2, para 1 Pakistani parturient who had severe mitral stenosis (mitral valve area 0.82 cm2, pressure gradient [peak/mean] 40/26 mmHg) and pulmonary hypertension (right ventricular systolic pressure of 87 mm Hg) and moderate aortic stenosis (aortic valve area 1.2 cm2, pressure gradient [peak/mean] 58/30 mmHg) from chronic rheumatic heart disease, had her pregnancy complicated by Rhesus iso-immunization. A transvenous mitral commissurotomy was performed percutaneously under local anesthesia. An emergency cesarean delivery for fetal distress was performed under general anaesthesia with sevoflurane and remifentanil. A live 1.73 kg flaccid male baby was delivered with a heart rate of 60 beats/min and treated with naloxone. The Apgar scores for the baby were 3 and 10 at 1 and 5 minutes respectively. Umbilical cord blood at delivery revealed venous and arterial pH of 7.36 (base excess +1) and 7.31 (base excess -2) respectively. The mother maintained stable haemodynamics and was extubated at the end of surgery. Both mother and baby were discharged from hospital on postoperative day 5. The use of remifentanil in cesarean section in patients with severe valvular heart disease is reviewed and discussed.


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