2016 Volume 36 Issue 4 Pages 420-424
We report a case of a 36-year-old primipara with interstitial pneumonia and mild pulmonary hypertension. Because of a decrease in oxygen saturation (SpO2) level, she was administered domiciliary oxygen therapy at 21 weeks of pregnancy. Cesarean delivery under combined spinal-epidural anesthesia (CSEA) was planned at 32 weeks and 6 days of pregnancy. An epidural catheter was inserted at L2/3, and hyperbaric bupivacaine (0.6 mL) and fentanyl (10 μg) were injected into the spinal subarachnoid space from L3/4. During the surgery, a local anesthetic drug was also administered through the epidural catheter whenever necessary (sequential CSEA). The level of anesthesia was below the level of Th6 both before and after the surgery.
High spinal anesthesia may lead not only to hypoxemia but may increase the severity of pulmonary hypertension as well. Through the use of sequential CSEA, this case could be managed and stable hemodynamics achieved while avoiding unexpected rise in the level of anesthesia.
