Anaesthetic Management of Parturient with Severe Mitral Stenosis Planned for Elective Caesarean Section for Safe Confinement

Abstract

Perioperative management of pregnant women with cardiac disease is challenging. The physiological cardiac changes that occur during late pregnancy leads to haemodynamic stress to the patient with the cardiac disease during and immediately after parturition. Pregnant women with severe valvular disease do not tolerate haemodynamic changes associated with pregnancy. The choice of anaesthesia technique either general anaesthesia or regional anaesthesia is depending on the haemodynamic goals, cardiac status of the patient, and mode of delivery. A 23-year-old female patient was planned for elective caesarean section for safe confinement. She was an operated case of Balloon Mitral Valvuloplasty (BMV). General anaesthesia was preferred due to the severity of mitral stenosis. Incorporation of epidural analgesia with general anaesthesia provided intraoperatively haemodynamic stability during laryngoscopy, intubation, and extubation. Also, postoperatively analgesia could be achieved due to epidural top-ups. Ultimately, a good perioperative outcome has been achieved due to haemodynamic stability which reduces perioperative morbidity and mortality of the patient.

Keywords

• haemodynamic changes
• perioperative care
• pregnancy