Anaesthetic management in peripartum cardiomyopathy: Case Series

Abstract

Peripartum cardiomyopathy (PPCM) presents a unique challenge to clinicians due to its unpredictable onset and potentially life-threatening complications during the peripartum period. The choice of anaesthetic technique should prioritize hemodynamic stability, avoiding agents that depress myocardial contractility or cause systemic vasodilation. We have documented 4 patients with peripartum cardiomyopathy with various signs and symptoms such as fatigue, dyspnoea, chest pain, or severe left ventricular (LV) dysfunction. Depending on the patients’ condition, we have chosen epidural anaesthesia in 3 patients and combined spinal and epidural anaesthesia (CSEA) in 1 patient. Incremental doses of 10-12 mL of 0.75% Ropivicaine with 50mcg Fentanyl as 3-4 mL boluses were given. Intra-operative procedures were uneventful. Monitoring was done post-operatively. As per theoretical concern, this group of patients are at risk and so proper choice of anaesthesia, intra-operative management, post-operative care along with multi-disciplinary approach is crucial that too most importantly in third trimester.