Anesthetic management in pregnant women with Fontan circulation: a case series

IF 0.8 Q3 ANESTHESIOLOGY

JA Clinical Reports Pub Date : 2024-04-18 DOI:10.1186/s40981-024-00706-3

Ai Fujita, Kazuhiro Shirozu, Midoriko Higashi, Ken Yamaura

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Abstract

Given the advances in medicine, women with Fontan circulation are now reaching childbearing age. However, data on the mode of delivery and anesthetic management of these patients are limited. We report the cases of five pregnant women with Fontan circulation. The mean age at delivery was 28 ± 3 years, and the mean gestational period was 34 weeks and 3 days. Anticoagulation therapy was switched from warfarin and aspirin to continuous intravenous heparin. The modes of delivery were scheduled cesarean section (C/S) in one, emergency C/S in three, and vaginal delivery with epidural labor analgesia in one patient. Three patients underwent C/S under regional anesthesia; one received general anesthesia. The perinatal complications were heart failure, worsening valve regurgitation, and postoperative hematoma in three, four, and two patients, respectively. For C/S in women with Fontan circulation, regional anesthesia should be considered. Epidural labor analgesia can help prevent the decrease in pulmonary blood flow due to straining. We initiated labor analgesia or C/S with regional anesthesia at the appropriate time in four patients.

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方坦循环孕妇的麻醉管理：病例系列

随着医学的进步，患有丰坦循环的女性如今已步入生育年龄。然而，有关这些患者的分娩方式和麻醉管理的数据却很有限。我们报告了五名患有丰唐循环的孕妇的病例。她们的平均分娩年龄为28±3岁，平均孕期为34周零3天。抗凝治疗从华法林和阿司匹林改为持续静脉注射肝素。1名患者的分娩方式为计划剖宫产（C/S），3名患者为紧急剖宫产，1名患者为阴道分娩加硬膜外分娩镇痛。三名患者在区域麻醉下进行了剖腹产，一名患者接受了全身麻醉。围产期并发症分别为3例、4例和2例患者出现心力衰竭、瓣膜返流恶化和术后血肿。对于患有丰坦循环的产妇进行剖宫产手术，应考虑采用区域麻醉。硬膜外分娩镇痛有助于防止因用力导致的肺血流减少。我们在四例患者中适时使用了分娩镇痛或区域麻醉进行剖宫产术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JA Clinical Reports ANESTHESIOLOGY-

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

9 weeks

期刊介绍： JA Clinical Reports is a companion journal to the Journal of Anesthesia (JA), the official journal of the Japanese Society of Anesthesiologists (JSA). This journal is an open access, peer-reviewed, online journal related to clinical anesthesia practices such as anesthesia management, pain management and intensive care. Case reports are very important articles from the viewpoint of education and the cultivation of scientific thinking in the field of anesthesia. However, submissions of anesthesia research and clinical reports from Japan are notably decreasing in major anesthesia journals. Therefore, the JSA has decided to launch a new journal, JA Clinical Reports, to encourage JSA members, particularly junior Japanese anesthesiologists, to publish papers in English language.