Sunday, February 20, 2011

Anarkali Suit Cutting

patient with a heart works only 15%, could be given anesthesia for the procedure [2]

But ultimately, the prognosis is not very good Kela. We do not know how that heart so weak you can handle the increased blood volume in the last trimester of pregnancy. In addition, she was receiving the drug
antiarrítimico

amiodarone during the first trimester of pregnancy. As a result, there is possibility of teratogenicity, ie congenital malformation.
We were told that there had been a medical board to determine whether to terminate the pregnancy (therapeutic abortion) in order to safeguard the lives of Kela. The two gynecologists and obstetricians present at the meeting felt that there. They argued that at that time the patient was stable from the cardiovascular standpoint. Of course, it was stable in early pregnancy, but did not ask how much "stability" was going to be at the end of it?


With good reason, was scheduled the procedure under local anesthesia. However, cardiovascular anesthesiology was there present, waiting.

All was well until, coincidentally, Kela was seized with a nervous breakdown and single-chamber pacemaker started to fail without even connected the two chambers. The cardiovascular anesthesiologist intervened by providing, first, ventilation and oxygenation as well as the maintenance of hemodynamic stability (blood pressure and heart rate).


Kela was necessary to sedate. But that heart is so weak, with only 15% of function (EF), could easily collapse with minimal dose of sedative.

That comes into play the cardiovascular anesthesiologist experience with this type of highly sensitive patients. First, we had to set a goal: to fall asleep without losing Kela spontaneous ventilation. Second, we had to use a single hypnotic drug, since the combination of two or more can add their cardiac depressant effects.
using propofol infusion at doses ranging from low to moderate Kela we get to sleep, while breathing at any time until the end of the procedure. The good quality of local anesthesia played a decisive role. There were no further incidents.



Kela left the procedure room in good condition. We wish him speedy recovery and a happy ending of her pregnancy, stating that we would accompany her at that time and, if so authorized their treating physicians, call us to be present at their cesarean.
Kela
luck.
Posted by admin at 10:11 PM

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