Low-dose sequential combined-spinal epidural anesthesia for Cesarean section in patient with uncorrected tetrology of Fallot

Abstract

Tetrology of Fallot (TOF) is the most commonly encountered congenital cardiac lesion in pregnancy. Although there are controversies regarding safe anesthetic technique for parturient with TOF, we use low-dose sequential combined-spinal epidural anesthesia in such a case posted for Cesarean section and found that low dose (0.5 ml of 0.5%) intrathecal bupivacaine and fentanyl with sequential epidural bupivacaine supplementation was adequate for the performance of an uncomplicated Cesarean section with minimal side effects and good fetal outcome. Thus, though the choice of anesthesia can vary in such patients, low-dose sequential combined-spinal epidural can be a safe alternate to achieve good anesthesia with impressive cardiovascular stability.