Anesthetic management of cesarean section in a patient with idiopathic hypertrophic subaortic stenosis

Abstract

Anesthetic management of the parturient with IHSS undergoing abdominal delivery is complex. Adequate preload and afterload must be maintained, which relatively contraindicates regional anesthesia. Myocardial contractility must be depressed, for which the volatile anesthetics are useful, but the ideal anesthetic for this is not available as the increased heart rate from isoflurane, decreased SVR from enflurane and isoflurane, and potential for ventricular ectopy with halothane all pose potentially serious problems. Ready availability of antidysrhythmics, vasopressors, cross-matched blood, beta-adrenergic blockers, and possibly calcium channel blockers is essential, and ergonovine is preferable to oxytocin for uterine contraction.