Anesthetic Management of High Risk Obstetric Patients with Pulmonary Hypertension: An Experience at Rawalpindi Institute of Cardiology

Abstract

Objectives: To assess the safety of mode of anesthesia in high risk patients of pulmonary Hypertension in terms of morbidity and mortality, and to compare these observations with international studies.

Methodology: This retrospective observational study was conducted at Rawalpindi Institute of Cardiology, from July 2017 till February 2019. All patients having pulmonary hypertension and undergone obstetric surgery were included. Diagnosed cases of pulmonary hypertension, who had conceived despite counseling against conception, and were registered at RIC during second or third trimester through emergency, and these patients were optimized by oral medication to control pulmonary hypertension. A multidisciplinary approach was adopted by involving gynaecologist, cardiologist, and anesthesiologist well before surgical intervention which led to a better outcome for these patients in terms of morbidity and mortality. All the information was collected via study proforma. Data was analyzed by SPSS version 20.

Results: All patients remained hemodynamically stable during anesthesia and postoperatively as was evident by postoperative TTE. Morbidity was seen in one patient who had prolonged ventilation for 3 days followed by a chest infection. There was no maternal mortality. Other patients were discharged during the week postoperatively.

Conclusion: It was observed that the optimal medical therapy of obstetric patients with PH by a multidisciplinary approach before any kind of anesthesia results in the least mortality and morbidity.