Anesth Pain Med.  2022 Jul;17(3):291-297. 10.17085/apm.21123.

Anesthetic management of cesarean delivery of parturient with systemic lupus erythematosus associated with pulmonary arterial hypertension - A case report -

• Lertkovit S
• Nivatpumin P

• KMID: 2535322
• DOI: http://doi.org/10.17085/apm.21123

Abstract

Background
Pulmonary hypertension in pregnancy is rare and leads to high maternal morbidity and mortality. Case: A 27-year-old parturient woman with a 31-week gestational age underwent cesarean delivery under combined spinal-epidural anesthesia. She had systemic lupus erythematosus associated with severe pulmonary arterial hypertension. The operation was done in the cardiac theatre along with meticulous invasive monitoring. Insertion of femoral artery and femoral vein catheters for veno-arterial extracorporeal membrane oxygenation was done before delivery as preparation for the potential emergency of a life-threatening form of decompensated cardiac failure. During the delivery, the patient suddenly developed increased pulmonary arterial pressure. This was controlled by the continuous infusion of intravenous milrinone. Conclusions: We report the successful management of this patient in the perioperative period. For cases such as that reported here, we recommend multidisciplinary team collaboration coupled with invasive cardiovascular monitoring and scrupulous anesthetic management.

Keyword

Anesthesia; Cesarean delivery; Extracorporeal membrane oxygenation; Milrinone; Pulmonary arterial hypertension; Systemic lupus erythematosus

Figure

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  Fig. 1. Preoperative chest radiograph.

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  Fig. 2. A cardiac surgeon inserted an introducer sheath for ECMO to the right groin after spinal-epidural anesthesia was performed; before starting cesarean delivery. ECMO: extracorporeal membrane oxygenation.

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  Fig. 3. Postoperative chest radiograph.

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