Epidurals Can Aid Parturients With Aortic Stenosis


HOLLYWOOD, FLA. — Maintaining hemodynamic stability is particularly important in the anesthetic management of parturients with aortic stenosis, and the use of a slowly titrated epidural or combined spinal-epidural with a reduced spinal anesthesia dose appears to provide this stability in most patients, findings from a case series suggest.

The cases, including six patients with moderate aortic stenosis and six with severe aortic stenosis, also suggest that invasive monitoring facilitates anesthetic management in some patients, and that special attention to postoperative analgesia, monitoring, and volume status can prevent hemodynamic instability and complications, Dr. Alexander Ioscovich reported in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

The 12 patients were treated at two university hospitals, and compose all the cases of aortic stenosis in parturients seen at those hospitals from 1990 to 2005. Five of six patients with moderate aortic stenosis, and three of six with severe aortic stenosis had regional anesthesia; two with moderate aortic stenosis, and four with severe aortic stenosis had invasive monitoring; and one with critical symptomatic aortic stenosis had intraoperative transesophageal echocardiography under general anesthesia. There were no cases of hemodynamic instability or anesthetic complications, although one patient had a failed epidural, wrote Dr. Ioscovich of Sunnybrook Women's College Hospital, Toronto.

Although neuraxial anesthesia has traditionally been considered contraindicated in aortic stenosis patients, the findings suggest this approach is useful in all but the most severe cases, he concluded.

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