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Low Dose Bupivacaine Spinal Anesthesia For Emergency Cesarean Sectio In A Patient with Uncorrected Tetralogy of Fallot , Presenting With Placenta Previa.

Introduction. 01. TOF (5-6 % ) of congenital heart disease.

Case Report. A dmitted in emergency ward with complaint of vaginal bleeding with contraction and breathlessness on routine work..

Placenta Previa. In physical examination, she had clubbing finger grade IV , cyanosis peripheral and central.

I nformed consent before the operation The patient remained fasting put in iv line and had been given ringer lactat fluid, ranitidine iv 50 mg, and ondansentron 4 mg iv before induction. O ne packed red cell (PRC) 250 cc prepared. A low dose spinal anesthesia was planed. In the operating theatre : 5 lead ECG Noninvasive blood pressure Pulse oxymetri Oxygen supplementation continued.

Anesthetic management. L ow dose spinal anesthesia was given using 5 mg of hyperbaric bupivacaine and 25 μg of fentanyl in sitting position through L3-L4 interspace using spinocath 27 G into the subarachnoid space.

Anesthetic management. The analgesic given are ketorolac injection per 8 hours, paracetamol drips 1 gr per 8 hours and fentanyl syringe pump 16 mcg per hour . The patient was comfortable, and pain-free with no respiratory distress at the end of the surgery..

Anesthetic management. The patient was transferred to recovery room after surgery with stable hemodynamic and bromage score 2.

Discussion. TOF patients tolerate physiological changes of pregnancy depending on corrective or palliative procedure, whether any residual defects remain after the procedure, the functional status of the patient before pregnancy and presence of pulmonary hypertensi on..

Discussion. general anesthesia (GA) was considered a gold standard for managing anesthesia of patients with congenital heart disease (CHD).

Discussion. In this case we used low dose spinal hyperbaric bupivacaine 5 mg combined with fentanyl 25 mcg produces adequate block with minimal systemic side effects.

Discussion. . A case report in India discussed the management of anesthesia with low dose spinal anesthesia using bupivacaine 6 mg with adjuvant fentanyl 25 mcg in a cesarean section patient with uncorrected tetralogy of Fallot presenting with abruptional plasenta to avoid a decrease in SVR and an increase in PVR ..

Discussion. Fentanyl acts synergistically as an adjuvant with bupivacaine in lowering the pain threshold without increasing sympathetic blockade ..

Conclusion. Pregnancy can carry high risk in patient with congenital heart disease presenting with plasenta previa . If the patients require surgery, the choice of regional and general anesthesia adapted to the patient’s condition. Low dose spinal anesthesia combined with fentanyl as adjuvant can be be considered as an alternative technique to general anesthesia, in selected parturients with uncorrected TOF presenting for cesarean section, especially in cases where the risks of administering a general anesthetic are deemed high. Postoperative patients with condition like this case should remain closely monitored to avoid possible worsening of the right-to-left shunt..

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