Abstract
BackgroundAlthough rare, long-lasting fetal tachyarrhythmia often leads to fetal heart failure and hydrops. Some mothers receive transplacental treatment of fetal tachyarrhythmia (TTFT), which can potentially worsen maternal hypotension and bradycardia. Moreover, the use of rescue cardiovascular agents intraoperatively can worsen fetal tachycardia. However, reports of the anesthetic management of patients receiving TTFT are rare.Case presentationA 31-year-old woman who was receiving digoxin and sotalol for TTFT underwent planned elective cesarean section. The fetus had hypoplastic left heart syndrome, hydrops, and tachycardia. We used combined spinal-epidural anesthesia with a reduced dose of local anesthetic. We also employed a non-invasive continuous hemodynamic monitoring system. The mother’s systolic blood pressure remained at ≥ 90% of the baseline value; intraoperative administration of rescue cardiovascular agents was not required.ConclusionsWe successfully anesthetized a woman for cesarean section, who was receiving TTFT for fetal tachyarrhythmia, using combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring.
Highlights
ConclusionsWe successfully anesthetized a woman for cesarean section, who was receiving treatment of fetal tachyarrhythmia (TTFT) for fetal tachyarrhythmia, using combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring
Rare, long-lasting fetal tachyarrhythmia often leads to fetal heart failure and hydrops
We successfully anesthetized a woman for cesarean section, who was receiving treatment of fetal tachyarrhythmia (TTFT) for fetal tachyarrhythmia, using combined spinal-epidural anesthesia and non-invasive continuous hemodynamic monitoring
Summary
As care improves for infants born with congenital cardiac abnormalities, the use of TTFT will likely increase. There are several important anesthetic considerations in patients who are receiving this type of treatment, including the risk of maternal bradycardia and hypotension, as well as the potential risks of using rescue cardiovascular agents. In this case, we successfully provided a safe and effective anesthetic using CSEA and non-invasive continuous hemodynamic monitoring in a patient undergoing cesarean section who was receiving a combination of digoxin and sotalol for TTFT
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