Résumé
Non-valvular heart disease is an important cause of cardiac disease in pregnancy and presents a unique challenge to the anesthesiologist during labor and delivery. A keen understanding of the underlying pathophysiology, in addition to the altered physiology of pregnancy, is the key to managing such patients. Disease-specific goals of management may help preserve the hemodynamic and ventilatory parameters within an acceptable limit and a successful conduct of labor and postpartum period..
Sujets)
Anesthésie générale/méthodes , Anesthésie obstétricale/méthodes , Cardiomyopathies/physiopathologie , Cardiomyopathies/chirurgie , Complexe d'Eisenmenger/physiopathologie , Complexe d'Eisenmenger/chirurgie , Femelle , Cardiopathies congénitales/physiopathologie , Cardiopathies congénitales/chirurgie , Cardiopathies/physiopathologie , Cardiopathies/chirurgie , Humains , Hypertension pulmonaire/physiopathologie , Hypertension pulmonaire/chirurgie , Infarctus du myocarde/physiopathologie , Infarctus du myocarde/chirurgie , Grossesse/physiologie , Complications cardiovasculaires de la grossesse/physiopathologie , Complications cardiovasculaires de la grossesse/chirurgie , Tétralogie de Fallot/physiopathologie , Tétralogie de Fallot/chirurgieRésumé
Complete tracheal resection is extremely rare after blunt chest trauma. A high degree of suspicion is essential to identify these cases and early intervention is associated with better outcome. We report a patient with complete tracheal resection, in whom the airway was secured whilst the patient remained awake, breathing spontaneously under fibreoptic bronchoscopic guidance. As a precautionary measure, we had kept cardiopulmonary bypass set up in readiness. Anaesthetic management needed to be modified during repair of the trachea, by using total intravenous anaesthesia with propofol and rocuronium infusion and insertion of a separate endotracheal tube into the distal portion of the trachea whilst reconstruction of the trachea took place. The usual inhalational technique could not be used. The anaesthesiologist managing such a case should be aware of the difficulties during securing the airway and during repair of the trachea. Proper planning and keeping back-up plans ready helps in successful management of these patients.