Epidural Anaesthesia for LSCS in Hypertrophic Cardiomyopathy: A Better Choice.

Hypertrophic cardiomyopathy (HCM) is a complex cardiovascular disorder with autosomal dominant inheritance, having an incidence of 0.1-0.5% in pregnant females. Anesthetic management of female with HCM posted for caesarean section is a challenge, as even minor alteration in hemodynamic status during the perioperative period may endanger the life of the patient. Here we report successful management of one patient with HCM for LSCS using epidural anaesthesia.

Bilateral Pheochromocytoma: An anesthetic challenge.

Pheochromocytoma is a rare catecholamine secreting neuroendocrine tumor. It is bilateral in 10% of cases. A 24 year lady with bileteral Pheochromocytoma operated for resection under epidural with general anesthesia. Diagnosis was confirmed with 24 hour urinary VMA levels, USG, CT scan and MIBG scan. Tumor resection was incomplete on left side so patient underwent reexploration. Preoperative BP controlled with Phenoxybenzamine and Prazocine. Intra-operative BP fluctuations managed with sodium nitropruside and esmolol. Post operative hypotension was tackled with higher doses of Dopamine and Noradrenline due to down regulation of adrenergic receptors. Patient was discharged on oral steroids after 3 weeks.