Low-dose sequential combined spinal-epidural: an anaesthetic technique for caesarean section in patients with significant cardiac disease

• Published in: International journal of obstetric anesthesia Vol. 14; no. 4; pp. 355 - 361
• Main Authors: Hamlyn, E.L., Douglass, C.A., Plaat, F., Crowhurst, J.A., Stocks, G.M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-10-2005
• Subjects: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia, Spinal; Cardiac disease; Cesarean Section; Echocardiography; Female; Heart Diseases; Humans; Intraoperative Care; Invasive monitoring; Maternal mortality; Monitoring, Intraoperative; Multidisciplinary team; Pregnancy; Pregnancy Complications, Cardiovascular; Regional anaesthesia; Maternal mortality; Echocardiography; Multidisciplinary team; Cardiac disease; Invasive monitoring; Regional anaesthesia
• ISSN: 0959-289X; 1532-3374
• DOI: 10.1016/j.ijoa.2005.01.001

In the United Kingdom, cardiac disease is the second most common cause of all maternal deaths. The best anaesthetic technique for caesarean section in these patients has yet to be established. We describe a low-dose combined spinal-epidural technique in four high-risk obstetric patients who presented to this unit. Invasive monitoring was used in each case, and drugs with significant cardiovascular effects were avoided or used with extreme caution. Multidisciplinary team involvement, including serial echocardiography in the antenatal period, is strongly recommended.