General anesthesia for primary pulmonary hypertension patient during labour: a case report

ABSTRACT

The management of PPH is a challenge for the anesthesiologist because the risk of right sided heart failure and mortality are markedly increased. Here we describe a case of a 25-year- old pregnant woman presenting with severe PPH with high systolic pulmonary artery pressure [SPAP] that equals the systemic arterial blood pressure. Her Echocardiogram showed severe right ventricular [RV] dilatation and hypertrophy [RVH], she had an elective Caesarean section under general anesthesia at 32 weeks gestation. Pulmonary artery pressure [PAP] measured by a pulmonary artery catheter before induction of anesthesia was 102 mm Hg! Intraoperatively; nitroglycerin and nitric oxide [NO] were used to reduce SPAP. After the delivery of a healthy infant; she was transferred to the critical care unite where extubation done after 9 hours later. SPAP was controlled with NO 20 p.p.m while patient still intubated. After extibation, nitroglycerin, nebulized iloprost, and silandifil used to control PAP. Five days later she transferred from intensive care, and discharged from hospital on day 14. She maintained on silandifil 50 mg three times daily and warfarin. She was given the appropriate outpatient clinic appointments to be referred to the heart lung transplant service