Abstract
A 25-year-old woman with hypertrophic obstructive cardiomyopathy underwent elective cesarean section under epidural anesthesia. Two percent lidocaine was injected via 2 epidural catheters inserted at T12/L1 and L4/5. Surgery was commenced following the dermatomal level of analgesia reached T8. Intravenous oxytocin was administered immediately after delivery for uterine contraction. However, the patient subsequently developed dyspnea and hypotension. Transthoracic echocardiography revealed diffuse left ventricular hypokinesis and exacerbation of tricuspid regurgitation. Based on these findings, acute exacerbation of chronic heart failure due to volume overload secondary to rapid uterine contraction was suspected. Subsequently, the patient was placed in semi-Fowler's position and on assisted respiration using mask ventilation, which stabilized her hemodynamic status. This case demonstrates that adequate evaluation of hemodynamic status is important for anesthetic management of patients with cardiac disease.
