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Sectio Caesarea with Epidural Anesthesia on G5P4A0 with Fetal Hypoxia, Severe Preeclampsia, Pulmonary Edema e.c. Dilated Cardiomyopathy NYHA IV
Research Article
10.47310/iarjacc.2022.v03i06.002
RTH Supraptomo
Keywords
Severe Preeclampsia; Fetal Hypoxia; Pulmonary Edema; Sectio Caesarea; Regional Anesthesia; Levobupivacaine; Fentanyl.
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Abstract
Introduction: The maternal mortality rate in Indonesia is still one of the highest in Southeast Asia. Hypertension in pregnancy is one of the main causes of maternal and fetal morbidity and mortality. Superimposed severe preeclampsia (sPE) is a condition of hypertension and proteinuria that appears before 20 weeks of gestation. Sectio Caesarea (SC) is an artificial delivery in which the fetus is delivered through an incision in the front wall of the abdomen and the lower uterine segment. One of the indications for immediate cesarean delivery is pulmonary edema in sPE Case Report: A 39-year-old woman with G5P4A0 33 weeks of gestation with Fetal hypoxia, sPE, Pulmo edema ec. Dilated Cardiomyopathy NYHA IV, and physical status ASA III-E was planned for CS emergency. The operation was performed using epidural anesthesia. The anesthetic used was a combination of levobupivacaine and fentanyl. Discussion: Regional anesthesia is more widely used in SC because it is fast and comfortable for operation, and the quality of analgesia is good postoperatively. Regional anesthesia is also associated with less hemodynamic fluctuations. Levobupivacaine works by blocking neuronal sodium channels that prevent depolarization and is reversible in both sensory and motor nerves. Administration of fentanyl in combination can result in prolonged sensory block without any difference in the onset of spinal anesthesia. Conclusion: Section caesarea emergency was performed using epidural anesthesia with a combination of levobupivacaine and fentanyl anesthetic drugs. The combination aims to prolong the duration of sensory block without prolonging the duration of motor block to reduce pain in the patient without interfering with his motor function.
PUBLISHED
Nov. 10, 2022
ISSUE
Volume :3 | Issue:6 (2022)
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