[Perioperative management for cesarean section in a patient with pulmonary thromboembolism due to deep venous thrombosis].

It has been estimated in Japan that Western-life style increases maternal mortality because of pulmonary thromboembolism (PTE). We report a 29-year-old primipara who suffered PTE due to deep venous thrombosis (DVT) in her 29th weeks' gestation. Except for slight tachypnea, she was relatively stable. Anticoagulation with heparin was started immediately. The retrievable inferior vena cava filter (IVC-F) was inserted. Four hours before surgery with discontinuation of heparin, the cesarean section was performed under general anesthesia. We used transesophageal echocardiography, a pulmonary artery catheter and end tidal CO2 monitoring for early detection and rapid management of recurrent PTE. She had no trouble during operation and her baby was born without serious symptoms. After recovery from anesthesia, she was admitted to the intensive care unit. Heparin was restarted after confirmation of hemostasis. On the 3rd postoperative day, we started thrombolytic therapy with urokinase which was tapered off during a week. Heparin was switched to warfarine gradually. On the 10th postoperative day, IVC-F could not be removed because of remaining DVT. She was discharged on daily warfarine. We experienced the perioperative management for cesarean section at 29 weeks' gestation following PTE due to DVT.

[Anesthesia for anticoagulated patients].

BACKGROUND: Anticoagulated patients who undergo surgry have been increasing in number. They may develop thrombo-embolic and/or bleeding complications. METHODS: We studied 79 patients retrospectively who had undergone elective surgery from April 2002 through December 2003. We studied their basal diseases, types of anticoagulants, stopping or continuing anticoagulants during their surgical period, thrombo-embolic and/or bleeding complications and changing of the anesthetic method. RESULTS: Thrombo-embolic complications occurred in 2 patients (2.5%) who developed brain emboli. Both of them had arythmia. Bleeding complications occurred in 4 patients (5.1%), of whom 3 patients developed bleeding during spinal or epidural anesthesia and one of them had hematoma from the surgical wound. There was no mortality, and 28.8% of patients underwent change of anesthetic method where only general anesthesia was used. CONCLUSIONS: It is recommended that patients at high risk of thrombo-embolism should continue to receive anticoagulant or heparin during surgical period.

[Cesarean section in a patient with severe mitral stenosis after mitral valve replacement].

A 30-year-old woman with mitral stenosis after mitral valve replacement was scheduled for cesarean section at 28 weeks and 6 days of pregnancy. Cesarian section was decided at a conference of obstetrics, cardiac surgery, neonatology and anesthesiology. Anesthesia was successfully managed with epidural block and pulmonary arterial pressure monitoring. During operation, blood pressure was controlled by dopamine, milrinone and phenylephrine. Patient did not develop cardiac insufficiency perioperatively. Cardiac function deteriorated gradually and reoperation of mitral valve replacement was performed 2 months later.