| Peripartum anesthetic management of patients with aortic valve stenosis: a retrospective study and literature review. | |
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MedLine Citation:
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PMID: 19733057 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Anesthetic management of parturients with aortic stenosis is controversial. Early studies suggest maternal mortality was related to cardiac condition and anesthetic care. In this report, management of parturients with moderate or severe aortic stenosis in two institutions is compared, and published cases are reviewed. METHODS: Peripartum anesthetic management of all parturients with moderate or severe aortic stenosis who gave birth between 1990 and 2005 at our institutions, is described. Patients with mild or non-valvular aortic stenosis were excluded. RESULTS: There were 12 parturients, six with moderate and six with severe aortic stenosis. Two patients with moderate aortic stenosis were New York Heart Association (NYHA) classification II, the others were asymptomatic. Five patients with severe aortic stenosis were symptomatic (NYHA classification II or III). Two patients with moderate and three with severe aortic stenosis underwent cesarean delivery; epidural anesthesia was used for two. Two patients with moderate and all with serious aortic stenosis were observed postpartum for 24 to 48 h in a high-dependency unit. There were no severe maternal or neonatal complications. CONCLUSIONS: Carefully titrated regional analgesia is usually well tolerated in patients undergoing vaginal or cesarean delivery even in the presence of severe aortic stenosis. Standard monitoring is usually adequate for vaginal delivery, but invasive monitoring may facilitate management in some patients. An arterial line allows close monitoring of systemic blood pressure. Facilities for close 24-48-h post-partum observation should be available. A multidisciplinary approach is needed. |
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Authors:
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A M Ioscovich; E Goldszmidt; A V Fadeev; S Grisaru-Granovsky; S H Halpern |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Review Date: 2009-09-03 |
Journal Detail:
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Title: International journal of obstetric anesthesia Volume: 18 ISSN: 1532-3374 ISO Abbreviation: Int J Obstet Anesth Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-09-28 Completed Date: 2009-12-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9200430 Medline TA: Int J Obstet Anesth Country: Netherlands |
Other Details:
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Languages: eng Pagination: 379-86 Citation Subset: IM |
Affiliation:
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Department of Anesthesia, Sunnybrook Health Sciences Centre, Mount Sinai Hospital, Toronto, Canada. aioscovich@gmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anesthesia, Epidural Anesthesia, General Anesthesia, Obstetrical / adverse effects* Aortic Valve Stenosis / complications*, physiopathology, ultrasonography Apgar Score Electrocardiography Female Gestational Age Hemodynamics Humans Infant, Newborn Monitoring, Intraoperative Parity Postpartum Period Pregnancy Pregnancy Complications, Cardiovascular* Pregnancy Outcome Retrospective Studies Vasoconstrictor Agents / adverse effects, therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Vasoconstrictor Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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