Neuroaxial anaesthesia in obstetrical patients with cardiac disease

Current Opinion in Anaesthesiology
Carmen Gomar, Carlos L Errando

Abstract

Pregnancy and the peripartum period represent a physiological burden for the cardiac patient that can worsen even moderate degrees of cardiac disease. Valvular stenotic diseases, congenital cardiac disease, and coronary insufficiency are relatively frequent in pregnant patients. Since considerable variability exists in the cardiovascular changes and responses to labour among different cardiac diseases and their functional status, recommendations for anaesthetic management are based on reported clinical experience and pathophysiological concepts. Neuroaxial blockade reduces or even abolishes the cardiovascular stress response to pain, mitigates Valsalva effects by decreasing the pushing reflex, and allows the adaptation of analgesia or anaesthesia to labour stage and delivery. Sympathetic blockade caused by standard neuroaxial techniques, however, reduces systemic vascular resistance and cardiac preload followed by reflex tachycardia. Recent development of neuroaxial techniques with spinal opiates for the first stage of labour, carefully titrated segmental epidural analgesia with opiates combined with low concentrations of local anaesthetic for the second stage, and even low spinal anaesthesia for vaginal instrumental delivery, ...Continue Reading

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Citations

Mar 23, 2013·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Gillian HiltonAlexander Butwick
Apr 20, 2011·Journal of Perinatal Medicine·Waltraut M MerzUlrich Gembruch
Dec 31, 2010·Indian Journal of Anaesthesia·M Kannan, G Vijayanand
May 26, 2009·International Journal of Obstetric Anesthesia·Alex T Sia, Ban L Sng
Aug 30, 2008·Best Practice & Research. Clinical Obstetrics & Gynaecology·Felicity Plaat, Sarah Wray
Jun 26, 2014·Acta Anaesthesiologica Scandinavica·Q ZhanY Fan
Jun 6, 2006·Journal of Cardiothoracic and Vascular Anesthesia·Pierre-Guy Chassot, Dominique A Bettex
Oct 12, 2011·Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre·Engin ErturkAhmet Eroglu
Jul 19, 2018·Current Treatment Options in Cardiovascular Medicine·Kate M CohenLisa R Leffert
Jun 13, 2018·A&A Practice·Marie-Louise MengRichard Smiley
Apr 27, 2007·Journal of Anesthesia·Krzysztof M Kuczkowski, André van Zundert
Feb 27, 2019·A&A Practice·Marie-Louise MengJessica Spellman
Feb 15, 2011·Anesthesiology·Menachem M WeinerRonald A Kahn
Mar 19, 2011·Current Opinion in Anaesthesiology·Eldrid Langesæter, Robert A Dyer
Feb 28, 2021·Journal of Cardiothoracic and Vascular Anesthesia·Deepak K Tempe

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