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首页> 外文期刊>Journal of International Medical Research >Perioperative management of emergent cesarean section in a patient with peripartum cardiomyopathy and orthopnea: a case report
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Perioperative management of emergent cesarean section in a patient with peripartum cardiomyopathy and orthopnea: a case report

机译：围手术治疗患有腹膜心肌病和Orthopnea的患者患者的围手术期管理：案例报告

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Perioperative management of pregnant women with heart failure is difficult. Management of anesthesia in pregnant women is especially difficult because all of the currently available choices present challenges. We report a patient with peripartum cardiomyopathy (PPCM) who required an emergent cesarean section and discuss the possible tactics for managing anesthesia. A 40-year-old primipara with severe cardiac and respiratory failure required an emergent cesarean section at 39 ~(+1) gestational weeks. Her left ventricular ejection fraction was between 10% and 15%, and she had orthopnea. General anesthesia was planned after inserting sheaths for percutaneous cardiopulmonary support from the femoral artery and vein. However, when the patient was asked to lie down on the operation bed, she panicked and resisted because of labor pain and dyspnea. Therefore, anesthesia was induced instead of the initial plan. Finally, we successfully managed the anesthesia and delivered the newborn. There are no alternatives to general anesthesia in patients with PPCM presenting with orthopnea. Anesthesia induction in the supine position is impossible in such patients owing to dyspnea. Anesthesia should be started with light sedation in the sitting position, and ketamine or low-dose remifentanil may be an option to maintain maternal hemodynamics and prevent neonatal asphyxia.
机译：心力衰竭孕妇的围手术期管理是困难的。在孕妇中麻醉的管理尤其困难，因为所有目前可用的选择都存在挑战。我们报告患有围属心肌病（PPCM）的患者，他们需要紧急剖腹产，并讨论可能的管理麻醉策略。具有严重心脏和呼吸衰竭的40岁的Pripipara需要妊娠剖宫产，妊娠期妊娠周。她的左心室喷射分数在10％和15％之间，而且她有正交。在插入股骨动脉和静脉的皮革心肺载体插入护套后计划全身麻醉。然而，当患者被要求躺在手术室上时，她因为植物疼痛和呼吸困难而恐慌和抵抗。因此，诱导麻醉而不是初始计划。最后，我们成功地管理了麻醉并交付了新生儿。 PPCM患者患有正矫形症患者的全身麻醉没有替代品。由于呼吸困难，在这些患者中，在仰卧位的麻醉诱导是不可能的。麻醉应在坐姿的光镇静中开始，氯胺酮或低剂量雷芬丹尼尔可以是维持母体血流动力学并防止新生儿窒息的选择。

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