Low Dose Spinal Anethesia For Sectio Cesarian Delivery in Patient

with Severe Mitral Stenosis

Dewi Puspitorini Husodo ** Ruddi Hartono* Isngadi* Djudjuk R. Basuki*
**Resident *Consultant
Department of Anesthesiology And Intensive Therapy
Faculty of Medicine Universitas Brawijaya, Malang, Indonesia

INTRODUCTION
Mitral stenosis is the most common rheumatic valvular lesion seen in pregnancy
due to its prevalence in young women. Approximately 25% of patients with mitral
stenosis become symptomatic for the first time during pregnancy. Some author said
neuraxial anesthesia is contraindicated due to the risk of hypotension after spinal
anesthesia.
RESULT(S)
Neuroaxial block was achieved in just 5 minutes. It’s seen stabilized hemodynamic prior to post injection,after
delivery, and post operative. There is no acute heart failure and decrease of hemodinamic in post operative
evaluation in ICU. The patient dismissed safely from hospital in the 7th day post operative.

OBJECTIVE Systole and Diastole Graph Saturation Graph

To prove the effectiveness of using low dose spinal anesthetic in combination with an opioid
adjuvant towards 24-years old primigravida, in labor at 32-34 weeks of gestation with Severe
Mitral Stenosis, Mild Mitral Regurgitation, Moderate Tricuspid Regurgitation, moderate
pulmonal regurgitation ( EF 62%), moderate pulmonal hypertension ( PASP 65mmhg) ,Heart
Failure st C Functional Class 3
Pulse Rate Graph CVP Graph

METHOD(S) CONCLUSION(S)
.low dose spinal anesthesia using 5 mg of bupivacaine heavy 0,5% and adjuvant opioid fentanyl 50 mcg can be
The caesarian section performed under low dose anesthesia used 5 mg of
bupivacaine heavy 0,5% and 50 mcg of Fentanyl with the total volume was 2 cc succesfully used for the performance of Cesarean delivery in severe mitral stenosis patient as regards to onset,
injected in less than 10 seconds through Tuffier’s line. adequacy level, duration of the block,haemodinamyc stability and good fetal outcome

REFERENCES ACKNOWLEDGEMENTS
Boom, CE. 2013. Panduan Klinis Perioperatif Kardiovaskular
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Gartner M, Youngblood C. Case report in anesthesiology: essential Dr. dr. Isngadi, M.Kes, SpAn, KAO
pulmonary hypertension in a primigravida. Anesthesiol Open J.
2016; 1(1): 24-27. doi: 10. dr. Djudjuk RB, SpAn, KAKV
Grindheim G, Estensen ME, Langesaeter E, Rosseland LA, Toska K. Department of Anesthesiology And Intensive Therapy
Changes in blood pressure during healthy pregnancy: A longitudinal Faculty of Medicine Universitas Brawijaya, Malang,
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10.1097/HJH.0b013e32834f0b1c. CONTACT INFORMATION
Isngadi, Rafidya IS. 2017. Manajemen Anestesi Pada Kehamilan
Dengan Penyakit Jantung . Departemen Anestesiologi dan Terapi dr. Dewi Puspitorini Husodo
Intensif FKUB RSUD Dr.Saiful Anwar, Malang. 2017 : 78. dewihusodo@gmail.com