Obstetric anesthesia management of dilated cardiomyopathies and heart failure: a narrative review

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia Pub Date : 2024-08-14 DOI:10.1016/j.ijoa.2024.104251

M.L. Meng , J. Schroder , K. Lindley

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引用次数: 0

Abstract

Pregnancy in patients with dilated cardiomyopathy carries a significantly increased risk of maternal mortality or severe morbidity, and pregnancy is typically considered contraindicated for patients with severely reduced ventricular function. Nonetheless, anesthesiologists will still encounter patients with cardiomyopathy requiring delivery or termination care. This review describes how NT-ProBNP testing and echocardiography can help with early recognition of heart failure in pregnancy, and describes a suggested approach to anesthetic management of patients with cardiomyopathies or acute heart failure, including hemodynamic goals, use of vasoactive medications and mechanical support. Vaginal delivery, with effective neuraxial anesthesia is the preferred mode of delivery in most patients with cardiomyopathy, with cesarean delivery reserved for maternal or fetal indications. The Pregnancy Heart Team is vital in coordinating the multidisciplinary care necessary to safely support these patients through pregnancy.

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扩张型心肌病和心力衰竭的产科麻醉管理：综述

扩张型心肌病患者怀孕会显著增加孕产妇死亡或严重发病的风险，而且心室功能严重减退的患者通常被视为禁忌怀孕。尽管如此，麻醉医师仍会遇到需要分娩或终止妊娠护理的心肌病患者。本综述介绍了 NT-ProBNP 检测和超声心动图如何帮助早期识别妊娠期心力衰竭，并介绍了对心肌病或急性心力衰竭患者进行麻醉管理的建议方法，包括血液动力学目标、血管活性药物的使用和机械支持。阴道分娩和有效的神经麻醉是大多数心肌病患者的首选分娩方式，剖宫产仅适用于母体或胎儿适应症。妊娠心脏病小组在协调必要的多学科护理以安全支持这些患者度过妊娠期方面至关重要。

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

International journal of obstetric anesthesia 医学-妇产科学

CiteScore

4.70

自引率

7.10%

发文量

285

审稿时长

58 days

期刊介绍： The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.