Cesarean section and primary pulmonary hypertension: the role of intravenous dexmedetomidine

Int J Obstet Anesth. 2009 Jul;18(3):262-7. doi: 10.1016/j.ijoa.2008.08.001. Epub 2009 Jan 20.

Abstract

Primary pulmonary hypertension is a fatal disease that frequently becomes evident in pregnancy. The management of pregnant women with primary pulmonary hypertension poses a number of difficult problems, especially where regional anesthesia is considered to be contraindicated. A 30-year-old woman who developed primary pulmonary hypertension at 23 weeks of pregnancy was transferred to our hospital. Systolic pulmonary artery pressure and plasma brain natriuretic peptide levels were markedly elevated. Nitric oxide inhalation and prostacyclin prevented the progression of cardiac failure and reduced both plasma brain natriuretic peptide and pulmonary artery pressure. Cesarean section was performed at 32 weeks under general anesthesia. A combination of nitric oxide, prostacyclin, nitroglycerin, and dobutamine were administered during surgery. Intravenous dexmedetomidine was specifically used during emergence and recovery from anesthesia. This provided effective pain relief and hemodynamic stability. Throughout the clinical course, brain natriuretic peptide levels was monitored and used as an indicator of cardiac failure.

Publication types

  • Case Reports

MeSH terms

  • Adrenergic alpha-Agonists / administration & dosage*
  • Adult
  • Anesthesia, Obstetrical / methods*
  • Cesarean Section*
  • Dexmedetomidine / administration & dosage*
  • Female
  • Heart Failure / prevention & control
  • Humans
  • Hypertension, Pulmonary / drug therapy*
  • Hypertension, Pulmonary / physiopathology
  • Natriuretic Peptide, Brain / blood
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / drug therapy*
  • Treatment Outcome

Substances

  • Adrenergic alpha-Agonists
  • Natriuretic Peptide, Brain
  • Dexmedetomidine