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Journal of Obstrectic Anaesthesia and Critical Care
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CASE REPORT
Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 50-52

Anesthetic management of caesarean section in a patient with double outlet right ventricle


Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

Correspondence Address:
Rohith Krishna
Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka-576104
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4472.99328

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Double outlet right ventricle (DORV) is a rare congenital heart defect involving the great arteries. In DORV, both aorta and pulmonary artery arise from the right ventricle resulting in admixture of blood. We report a 22-year-old parturient with DORV and severe pulmonary stenosis who underwent caesarean delivery at 36 weeks gestation with low dose combined spinal-epidural anesthesia. This lady was assessed by echocardiogram to have situs inversus, dextrocardia, severe pulmonary artery stenosis (gradient = 146 mm Hg), DORV with subarterial VSD (1 cm). She had 95% room air saturation and her blood investigations were within normal limits. We established a peripheral venous access and radial arterial line for continuous blood pressure monitoring. Combined spinal epidural anesthesia was considered a better option. Epidural catheter was secured at L 2 -L 3 space and fixed after giving test dose 3 mL 2% lignocaine. Subarachnoid block administered at L 3 -L 4 level using 1.2 mL of 0.5% heavy bupivacaine. A sensory block of T 10 was obtained which was supplemented with 4 mL 0.75% ropivacaine to obtain a level of T 6 . Patient tolerated the procedure well. She was shifted to post-operative ICU. Post-operative pain was managed with epidural 0.2% ropivacaine at 4 mL/h. Patient remained hemodynamically stable throughout the procedure and in the postoperative period while she was being followed up for subsequent 48 h.


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