Gây tê tủy sống và ngoài màng cứng kết hợp (CSE) để mổ lấy thai trên sản phụ bệnh lý tim mạch

The management of cesarean section in parturients with cardiovascular disease presents significant clinical challenges, requiring highly individualized anesthetic approaches to ensure maternal and fetal safety. Neuraxial anesthesia, particularly combined spinal-epidural anesthesia (CSE), is often preferred due to its ability to minimize systemic effects compared to general anesthesia. However, the unique hemodynamic changes associated with pregnancy and delivery, further complicated by underlying cardiac conditions, necessitate meticulous planning and execution. This paper aims to highlight the critical considerations and successful application of CSE in such high-risk obstetric cases, emphasizing the importance of multidisciplinary care and precise hemodynamic management.

Anesthesiologists, obstetricians, cardiologists, critical care specialists, and medical residents involved in maternal and fetal care, particularly those managing high-risk pregnancies with cardiovascular complications.

This academic paper addresses the complex anesthetic management of cesarean section in parturients with cardiovascular disease, presenting a compelling case report and a review of relevant practices. The authors underscore that while neuraxial anesthesia, specifically combined spinal-epidural anesthesia (CSE), is generally favored for its hemodynamic stability advantages over general anesthesia, each case demands a tailored approach. The core of the paper is a detailed account of a 22-year-old patient with ventricular premature contractions who successfully underwent a cesarean section using sequential CSE. The anesthetic technique involved specific dosages of bupivacaine and fentanyl intrathecally, followed by an epidural test dose and subsequent administration. Key to the successful outcome was continuous invasive arterial blood pressure monitoring and the prophylactic use of phenylephrine infusion to maintain hemodynamic stability, ensuring mean arterial pressure and heart rate remained within safe parameters. The procedure resulted in the delivery of a healthy newborn and a stable postoperative recovery for the mother, demonstrating the efficacy of this meticulously managed approach. The paper further discusses broader considerations for obstetric anesthesia in cardiovascular patients, including risk stratification, hemodynamic goals, and the management of potential complications like postpartum hemorrhage. The insights provide valuable guidance for clinicians in optimizing care for these vulnerable patients, emphasizing the need for robust monitoring, precise pharmacological intervention, and a collaborative multidisciplinary team approach to mitigate risks and improve outcomes.