Email this article 
Anesthetic Implications of Emergent Cesarean Section in a Parturient with Marfan Syndrome Complicated by Ascending Aortic Aneurysm and Heart Failure
Abstract
Cardiovascular comorbidities to the Marfan syndrome may induce hemodynamic instability especially in the parturients during labor or delivery. For anesthesiologists, it is challenging to maintain hemodynamic stability during Cesarean section in those patients with Marfan syndrome. Remifentanil is an ultra-short-acting opioid with rapid onset and offset of action which provides cardiovascular stability during surgery. Together with remifentanil, the use of a laryngeal mask airway can reduce the risk of hypertensive response followed by tracheal intubation. We describe the successful administration of remifentanil and application of laryngeal mask airway for emergent Cesarean section performed under general anesthesia in a patient with Marfan syndrome complicated by ascending aortic aneurysm and heart failure. The use of remifentanil (loading dose of 1 μg/kg for 1 min, 2 min before induction; thereafter continuous infusion dose of 0.1 μg/kg/min) was useful to maintain hemodynamic stability of the parturient throughout the surgery without neonatal respiratory depression.
Keywords: Ascending Aortic Aneurysm; Cesarean section; Laryngeal mask airway; Marfan syndrome; Remifentanil
Full Text:
PDFReferences
Ho NC, Tran JR, Bektas A. Marfan's syndrome. Lancet. 2005;366:1978–81.
Meijboom LJ, Vos FE, Timmermans J, Boers GH, Zwinderman AH, Mulder BJ. Pregnancy and aortic root growth in the Marfan syndrome: a prospective study. Eur Heart J. 2005;26:914–20.
Pyeritz RE. The Marfan syndrome. Annu Rev Med. 2000;51:481–510.
Allyn J, Guglielminotti J, Omnes S, Guezouli L, Egan M, Jondeau G, Longrois D, Montravers P. Marfan's syndrome during pregnancy: anesthetic management of delivery in 16 consecutive patients. Anesth Analg 2013;116:392–8.
Myre K, Raeder J, Rostrup M, Buanes T, Stokland O. Catecholamine release during laparoscopic fundoplication with high and low doses of remifentanil. Acta Anaesthesiol Scand. 2003;47:267–73.
Schwarz GL, Volmanen P, Albrechtsen S, Bjoernestad E. Remifentanil target-controlled infusion during second stage labour in high-risk parturients: a case series. Acta Anaesthesiol Scand. 2013;57:802–8.
Ismail SA, Bisher NA, Kandil HW, Mowafi HA, Atawia HA. Intraocular pressure and haemodynamic responses to insertion of the i-gel, laryngeal mask airway or endotracheal tube. Eur J Anaesthesiol. 2011;28:443–8.
Kwak HJ, Chae YJ, Lee KC, Kim JY. Target-controlled infusion of remifentanil for laryngeal mask airway insertion during sevoflurane induction in adults. J Int Med Res. 2012;40:1476–82.
Meijboom LJ, Vos FE, Timmermans J, Boers GH, Zwinderman AH, Mulder BJ. Pregnancy and aortic root growth in the Marfan syndrome: a prospective study. Eur Heart J. 2005;26:914–20.
Manalo-Estrella P, Barker AE. Histopathologic findings in human aortic media associated with pregnancy. Arch Pathol. 1967;83:336–41.
Lipscomb KJ, Smith JC, Clarke B, Donnai P, Harris R. Outcome of pregnancy in women with Marfan's syndrome. Br J Obstet Gynaecol. 1997;104:201–6.
Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 CCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Anesth Analg. 2010;111:279–315.
Foran JR, Pyeritz RE, Dietz HC, Sponseller PD. Characterization of the symptoms associated with dural ectasia in the Marfan patient. Am J Med Genet A. 2005;134A:58–65.
Lacassie HJ, Millar S, Leithe LG, Muir HA, Montaña R, Poblete A, Habib AS. Dural ectasia: a likely cause of inadequate spinal anaesthesia in two parturients with Marfan's syndrome. Br J Anaesth. 2005;94:500–4.
Fettes PD, Jansson JR, Wildsmith JA. Failed spinal anaesthesia: mechanisms, management, and prevention. Br J Anaesth. 2009;102:739–48.
Kim G, Ko JS, Choi DH. Epidural anesthesia for cesarean section in a patient with Marfan syndrome and dural ectasia -A case report. Korean J Anesthesiol. 2011;60:214–6.
Buser RT, Mordecai MM, Brull SJ. Combined spinal-epidural analgesia for labor in a patient with Marfan's syndrome. Int J Obstet Anesth. 2007;16:274–6.
Ornek D, Aydin GB, Kahveci K, Cicek F, Dikmen B. Anesthetic management of a child with both Marfan syndrome and Turner syndrome. J Anesth. 2012;26:442–4.
Han TH, Brimacombe J, Lee EJ, Yang HS. The laryngeal mask airway is effective (and probably safe) in selected healthy parturients for elective Cesarean section: a prospective study of 1067 cases. Can J Anaesth. 2001;48:1117–21.
Yao WY, Li SY, Sng BL, Lim Y, Sia AT. The LMA Supreme in 700 parturients undergoing Cesarean delivery: an observational study. Can J Anaesth. 2012;59:648–54.
Ioscovich A, Elstein D. Images in anesthesia: Transesophageal echocardiography during Cesarean section in a Marfan's patient with aortic dissection. Can J Anaesth. 2005;52:737–8.
Heesen M, Klöhr S, Hofmann T, Rossaint R, Devroe S, Straube S, Van de Velde M. Maternal and foetal effects of remifentanil for general anaesthesia in parturients undergoing caesarean section: a systematic review and meta-analysis. Acta Anaesthesiol Scand. 2013;57:29–36.
Richa F, Yazigi A, Nasser E, Dagher C, Antakly MC. General anesthesia with remifentanil for Cesarean section in a patient with HELLP syndrome. Acta Anaesthesiol Scand. 2005;49:418–20.
Saeki N, Taguchi S, Kawamoto M. Successful management of a patient with Marfan syndrome complicated with acute aortic dissection using landiolol during Cesarean section. J Anesth. 2010;24:277–9.
Chang CY, Yang JM, Lam CW, Chen PH. Successful management of aortic dissection in a patient with Marfan syndrome during pregnancy. Am J Obstet Gynecol. 2013;208:e3–6.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution 4.0 International License.
2013-2023 (CC-BY) Australian International Academic Centre PTY.LTD.
Advances in Bioscience and Clinical Medicine