ABSTRACT
There are increasing numbers of combined heart-lung transplants being carried out in young people for end-stage pulmonary disease. There have-to-date been few reports of pregnancy in heart-lung transplant recipients. We report on the successful outcome of three pregnancies involving two patients following heart-lung transplantation. The importance of an interdisciplinary approach to the care of such patients throughout pregnancy is clear. The deliveries were carried out by caesarean section under regional anaesthesia and the discussion focuses on the choice of anaesthesia along with the problems these patients present to the anaesthetist. Regional anaesthesia appears to be a safe technique in these patients. However, it is important to appreciate that the response to vasoactive drugs may be unpredictable and that intravenous fluid should be administered carefully as they are at risk of fluid overload and pulmonary oedema.
ABSTRACT
The effects of epidural analgesia on plasma calcitonin gene-related peptide (CGRP) values during and after hysterectomy were investigated in 14 healthy patients. In seven patients who received general anaesthesia alone for pelvic surgery, there were no significant changes in plasma CGRP concentrations. In the remaining patients, who received extensive epidural blockade in addition to general anaesthesia, there were again no significant changes in plasma CGRP values. This was in spite of profound sympathetic blockade, as shown by marked hypotension and a significant decline in plasma catecholamines. The epidural group of patients showed the expected attenuation of the glucose, cortisol and growth hormone responses to surgery. The results show that circulating CGRP is unlikely to be involved in the modulation of peripheral vascular tone during pelvic surgery under either general or epidural anaesthesia.
