Anesthesia & Clinical Research
Open Access

Abstract

Low Dose Hyperbaric Bupivacaine 5 mg Combined with 50 mcg Fentanyl for Caesarean Section Delivery in Patient with Maternal Heart Disease

Husodo DP, Isngadi I, Hartono R and Prasedya ES

Most of women with cardiovascular diseases show worsen clinical condition during pregnancy. That is caused by cardiovascular physiological change during pregnancy and increased demand of oxygen-metabolic system. Spinal anesthesia is the most used technique in section caesaria patient, but there’s worried about using spinal anesthesia in patient with cardiac disease due to sudden hemodynamic decrease. Recent studies have proved hemodynamic changes in spinal anesthesia is dose dependent. Dose decreased of spinal anesthesia have potency of inadequate block and change of maternal-fatal hemodynamic due to pain or uncomforted feeling. It can be prevented by using opiod adjuvant that has good effect in anesthesia block. This is retrospective study in 33 patients with maternal heart disease undergoing CS under low dose spinal anesthesia in Saiful Anwar Hospital Malang Indonesia from September 2017 until September 2018. The spinal regimen was 5 mg bupivacaine heavy 0,5% combined with 50 mcg fentanyl. We evaluated the hemodynamic preoperative, post injection of spinal anesthetics, post-delivery, at the end of surgery. We also evaluated bromage score, Apgar score of the baby, and relaxation satisfaction from obstetrician. Combination low dose spinal and opioid for the CS delivery show no significant hypotension effects. It stabilized the hemodynamic prior to injection, post injection, after delivery, post-operative as well as in the recovery room. Furthermore, target blocked was reached well in all cases, no significant changes in Apgar score of the baby, and obstetrician satisfied with motoric relaxation. Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0,5% and adjuvant opioid fentanyl 50 mcg can be successfully used for the performance of CS delivery as regards to onset, adequacy, level, duration of the block and hemodynamic stability and good fetal outcome, with impressive cardiovascular stability.