Anesthesia management of cesarean section in pregnant women with severe idiopathic pulmonary arterial hypertension

Lin Duomao; Zhao Liyun; Ma Jun

doi:10.3760/cma.j.issn.1673-4777.2017.03.021

Abstract：Objective To investigate anesthesia management of cesarean section in pregnant women with severe idiopathic pulmonary arterial hypertension (IPAH).Methods Clinical data of 9 pregnant women with severe IPAH who had cesarean section from January 2006 to March 2016 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.Eight women had continuous epidural anesthesia and one woman had general anesthesia.Cardiac output(CO),central venous pressure (CVP),mean pulmonary artery pressure(MPAP),mean arterial pressure (MAP),heart rate(HR) and pulmonary capillary wedge pressure (PCWP) were recorded.Cardiac index (CI),systemic vascular resistance (SVR) and pulmonary vascular resistance(PVR) were calculated.The volume of fluid transfusion and occurrence of adverse reactions were analyzed.Results Epidural anesthesia in 8 cases was effective,level of anesthesia T8-S5;hemodynamic parameters in 1 case who had general anesthesia was stable.Three patients died of pulmonary hypertension crisis.CO,CVP,MPAP,MAP,HR,CI,SVR,PVR in 6 patients after anesthesia and after delivery had no significant differences compared to those before anesthesia(P ＞ 0.05).The total volume of fluid transfusion was 110-1 000 ml;the mean volume of fluid transfusion was 310 ml;the volume ratio of crystalloid/colloid was 2 ∶ 3.The total blood loss was 100-800 ml;the mean blood loss was 250 ml;the total urine volume was 30-1 000 ml;the mean urine volume was 200 ml.Disease conditions in 6 patients were stable after operation.Conclusion Patients with IPAH have high risk of pulmonary hypertension crisis and death during perioperative period of cesarean section;epidural anesthesia is a reasonable option.