Epidural anesthesia for emergency cesarean section in a woman with Fontan circulation: A case report

Rationale: Anesthetic management of pregnant women with Fontan circulation remains challenging. There are few reports that describe the anesthetic management of cesarean section after Fontan surgery. Here, we present a case of successful epidural anesthesia in a woman with Fontan circulation who required emergency cesarean section. Patient concerns: A 29-year-old woman at gestational week 28 was scheduled for emergency cesarean section because of fetal distress. Her past medical history was significant for congenital transposition of the great arteries that had been treated by Fontan surgery 26 years earlier. Her postoperative course had been uneventful and she had reached a near normal level of activity with no arrhythmias or thrombotic complications. On presentation, her oxygen saturation was approximately 84% and she had digital clubbing. Arterial blood gas analysis showed a PCO2 of 35 mmHg, PO2 of 55.5 mmHg, and hemoglobin of 16.3 g/dL. Her blood coagulation parameters were within normal limits except for a high fibrinogen concentration (4.55 g/L). Diagnosis: The diagnosis was pregnancy requiring emergency cesarean section because of fetal distress. Interventions: Before anesthesia, a radial artery line was established for continuous measurement of blood pressure. An air pressure pump was placed on the patient's lower limbs and a low-dose dobutamine infusion was started. Next, epidural anesthesia was successfully performed at L2–3. Five milliliters of...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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Source: Surgical and Radiologic Anatomy - Category: Anatomy Source Type: research
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Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
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Source: Ochsner Journal - Category: General Medicine Tags: Ochsner J Source Type: research
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Source: Indian Journal of Radiology and Imaging - Category: Radiology Authors: Source Type: research
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Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
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Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
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Source: International Journal of Obstetric Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
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Source: Herz - Category: Cardiology Tags: Herz Source Type: research
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Source: The Israel Medical Association Journal - Category: General Medicine Tags: Isr Med Assoc J Source Type: research
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Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Research Article Source Type: research
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