Anesthetic Consideration in Patient posted for LSCS with RHD with Severe MS

Introduction: Rheumatic mitral stenosis forms 88% of the heart diseases complicating pregnancy in the tertiary referral centre in India. Case report: 27 year old G4P2L2A1 with 39 weeks of gestation with Rheumatic Heart Disease with severe Mitral stenosis with moderate mitral regurgitation and tricuspid regurgitation was posted for elective caesarean delivery. After doing preanaesthetic evaluation patient was managed conservatively with iv diuretics and inj metoprolol and patient status improved from nyha iv to ii. After taking written high risk consent,the patient was taken on OT table with Pre op vitals PR-84/min, BP =110/67mmhg, Sp02=99% in room air and during Intraop course Induction was done after premedication with Inj Etomidate 12 mg IV and scoline 75mg IV and was intubated orotrachealy with RSI technique with ETT of 7.0mm Bilateral air entry confirmed and fixed at 19 cm at corner of mouth. Anaesthesia was maintained with O2 at 100%@5L/min and isoflurane at 0.4-0.6 and inj Atracurium 15+5+5 mg IV and Inj Fentanyl 40 µg IV. Inj.Esmolol 5 mg IV was given at regular intervals to control tachycardia. Tab sildenafil was given via ryles tube.After delivery of the baby,20 IU of oxytocin was given via IV infusion and Inj. Furosemide 40 mg IV was also given.Total fluid input was 300 ml and she had an output of 250 ml.She was also given usg guided b/l TAP block using 40 ml of 0.25% Ropivacaine.She was extubated after giving neostigmine 2.5mg and glycopyrrolate 0.5mg IV.she maintained SPO2 of 99% on room air and was shifted to recovery room and oxygen supplemented pos operatively @6L/minPost op vitals:PR=89/min,BP=120/74mmhg and SPO2=100% Conclusion: Rheumatic mitral stenosis complicating pregnancy is still a frequent cause of maternal death. A better understanding of the physiological changes in pregnancy and the pathological impact of mitral stenosis over pregnancy and a multidisciplinary approach in diagnosis and management reduce the mortality and morbidity