Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus^®) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy

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• 作者：Nicolas Brogly ; Renato Schiraldi ; Laura Puertas ; Genaro Maggi ; ^{genaromaggi@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Eduardo Alonso Yanci ; Ever Hugo Martinez Maldonado ; Emilia Guasch Aré ; valo ; Fernando Gilsanz Rodrí ; guez
• 关键词：Caesarean section ; Cardiac monitoring ; Myocardiopathy
• 刊名：Brazilian Journal of Anesthesiology (English Edition)
• 出版年：2016
• 出版时间：May-June 2016
• 年：2016
• 卷：66
• 期：3
• 页码：329-332
• 全文大小：264 K

文摘

The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality.

Objective

To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus^®) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy.

Case report

We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus^® monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs.

Conclusion

This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future.