Anesthetic management for the peripartum care of women with Fontan physiology.

Autor: McCabe M; Loma Linda University, Department of Anesthesiology, Los Angeles, CA, USA., An N; UCLA, Department of Anesthesiology and Perioperative Medicine, CA, USA. Electronic address: anni@ohsu.edu., Aboulhosn J; Ahmanson/UCLA Adult Congenital Heart Disease Center, CA, USA., Schwarzenberger J; UCLA, Department of Anesthesiology and Perioperative Medicine, CA, USA., Canobbio M; Ahmanson/UCLA Adult Congenital Heart Disease Center, CA, USA., Vallera C; UCLA, Department of Anesthesiology and Perioperative Medicine, CA, USA., Hong R; UCLA, Department of Anesthesiology and Perioperative Medicine, CA, USA.
Jazyk: angličtina
Zdroj: International journal of obstetric anesthesia [Int J Obstet Anesth] 2021 Nov; Vol. 48, pp. 103210. Date of Electronic Publication: 2021 Jul 28.
DOI: 10.1016/j.ijoa.2021.103210
Abstrakt: Background: As outcomes for surgical palliation have improved, women with single ventricle congenital heart disease are surviving into their reproductive years and may become pregnant. The cardiovascular changes of pregnancy may stress the Fontan circulation and pose significant risk to the mother and fetus.
Methods: Pregnant women with Fontan physiology were identified from the Ahmanson/UCLA Adult Congenital Heart Disease Center database. A total of 37 pregnancies were identified between 2000 and 2019. Twenty live births from 19 patients were reviewed and compared for cardiac history, obstetric history, anesthetic management and cardiovascular outcomes.
Results: Median gestational age at delivery was 35 weeks. Ten of 20 births were by cesarean delivery. An epidural technique was used as the primary anesthetic for 19 deliveries and general anesthesia was used for one cesarean delivery. An arterial line was placed in the peripartum period for three deliveries. Central venous access was established in the peripartum period for one patient. The mean blood loss for cesarean deliveries was 626 mL (range 240-1200 mL). The mean net peri-operative intake/output was positive 93.5 mL. Three patients were briefly transferred to the intensive care unit postpartum for higher level monitoring and care.
Conclusion: Epidural anesthesia is safe and effective for both vaginal and cesarean deliveries. Judicious fluid management is critical in minimizing postpartum cardiovascular complications. Many patients do not require a higher level of care, invasive monitoring or central venous access during the peripartum period.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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