Escolar Documentos
Profissional Documentos
Cultura Documentos
Introduction
Latest management for maternal with heart
disease requiring surgery.
Techniques of regional anesthesia in patients
with heart disease need little adjustment.
Monitoring of fluid and several heart function.
hemodynamic
changes
that
Eisenmenger Syndrome
Abnormalities : pulmonary hypertension,
right-to-left shunting produces arterial
hypoxemia.
Clinical manifestations include dyspnoea,
clubbing, polycythemia, peripheral edema
and cyanosis.
Avoid decreased of SVR.
2. Mitral regurgitation
Pregnancy will induce a state of hyper
coagulation and systemic embolism.
Epidural anesthesia can prevent an increase in
SVR, and prevent pulmonary congestion.
Invasive blood pressure monitoring
Antibiotics profilaxis is recommended
GA : Ketamin and Pancuronium
3. Aorta Stenosis
In aorta stenosis, transvascular gradient will
progressively increased during pregnancy, this
is due to an increase in blood volume and
decrease in SVR.
Avoid tachycardia and bradycardia, maintain
intravascular volume and "venous return", avoid
aortocaval compression and myocardial
depression, maintain heart rate as the normal
condition because decrease in heart rate will
decrease cardiac output
4. Aorta Insufficiency
Epidural anesthesia is
preferable/recommended
Induction agent using etomidate,
5. Prosthetic Valves
The high risk of fetal and maternal
complications
The use of anticoagulant therapy is contra
indication for regional anesthesia.
GA: the use of an additional monitoring tool
such as CVP, PA catheter and A-Line
Conclusions
THANK YOU