The patient was also diagnosed with stage B class III functional The target is to minimize the decrease

The target is to minimize the decrease in SVR and

heart failure. The obstetrician decided to terminate the prevent hypotension due to spinal anesthesia. A
ANESTHESIA MANAGEMENT IN PATIENT WITH pregnancy by cesarean section. Management of anesthesia strategy to maintain stable hemodynamics during
UNCORRECTED DOUBLE OUTLET RIGHT was low dose spinal anesthesia bupivacaine 0.5% 7.5 mg + spinal anesthesia in cesarean section is using low
VENTRICLE UNDERWENT CESAREAN SECTION adjuvant fentanyl 50 mcg and epidural ropivacain 0.2%, total dose of bupivacaine combined with opioid adjuvant.5
Dendy Dwi Ramadhani1, Ruddi Hartono2, Isngadi3 volume 10 cc inserted 30 minutes after birth. In this case report, we found no episodes of
hypotension and desaturation.
1. Resident Department of Anesthesiology and Intensive Therapy

“
Hemodinamik Durante Op
Faculty of Medicine Universitas Brawijaya, Dr. Saiful Anwar Hemodinamik Durante Op
Hospital Malang 121
116 115 114 115 Management using low dose
2. Consultant of Cardiovascular Anesthesia Department of
111 110

spinal and epidural anesthetic

107 121 105 100
103 116 115 102 114 101 115
97 98 111 98

Anesthesiology and Intensive Therapy Faculty of Medicine

95 96 96 96 110 96

SUMMARY technique can be used as an

107 105 92 100 95
103 102 101 88
97 95 96 96 98 96 98
96

Universitas Brawijaya, Dr. Saiful Anwar Hospital Malang

92 75 95
72 88

alternative management of
65 65

3. Consultant of Obstetric Anesthesia Department of Anesthesiology

63 60 75
72 56 57
63 65 65

and Intensive Therapy Faculty of Medicine Universitas Brawijaya,

60

uncorrected DORV in
56 57
37 37 37 37 37 37 37 37

Dr. Saiful Anwar Hospital Malang 37 37 37 37 37 37 37 37

pregnancy.
INTRODUCTION
5

5
10

10
15
Nadi
15
30
SpO2
30
45
TDS
45
60
TDD
60
75
Suhu
75
90

90
The patient's condition prior to anesthesia must be
Nadi SpO2 TDS TDD Suhu considered carefully. Low dose spinal anesthesia
Pregnant patient with uncorrected double outlet right ventricle
(DORV) undergoing cesarean section is challenging for
anesthesiologist. Double Outlet Right Ventricle (DORV) is a
Blood pressure before spinal was 119/67 mmHg, MAP 83,
heart rate 83 bpm and 97% saturation using 3 lpm in nasal
cannula. Initial blood pressure at the time of surgery was
“
performed in the patient did not cause hypotension
because of lower intensity of sympathetic block. Thus,
vasodilation and decreased of SVR could be avoided.
congenital heart defect in which the aorta and pulmonary artery leave 105/54 mmHg, heart rate 114 bpm and 96% saturation using 3
the right ventricle partially or completely. In that situation, no blood lpm in nasal cannula. Hemodynamic was stable after baby born
vessels leave the left ventricle and blood from the left ventricle mixes REFERENCES
until the end of surgery. There was no complication during and 1. Chesnut DH. Principle and Practice of Obstetric
with blood in the right ventricle. Hemodynamic changes in pregnancy after surgery. The patient underwent postoperative observation Anesthesia. Pennsylvania: Elsevier Mosby-
with congenital heart disease are not well tolerated and can lead to in the ICU for 2 days then transferred to ward. Philadelphia; 2004, 707-33
cardiovascular complications.1-4 We reported a case of anesthesia 2. Boom CE. Perioperatif Kardiovaskular Anesthesia.
management using low dose spinal and epidural anesthetic technique Jakarta: Aksara Bermakna; 2013, 226
to reduce the risk of significant hemodynamic changes. DISCUSSION 3. Isngadi, Rafidya IS.2017.Manajemen Anestesi
Pada Kehamilan Dengan Penyakit Jantung.
The goals of anesthesia management in DORV patient include Departemen Anestesiologi dan Terapi Intensif FKUB
THE CASE maintaining cardiac output by maintaining preload, contractility, RSUD Dr. Saiful Anwar, Malang. 2017: 78
A 24-year-old woman with G1 P0000 Ab000, gestational age 30-32 heart rate, higher SVR of pulmonary vascular resistance (PVR) 4. Cintyandy R. Anestesia Jantung Kongenital. Jakarta:
weeks complained shortness of breath since early pregnancy. to avoid increased systemic venous blood recirculation.1 Low 5. Aksara Bermakna; 2014,165-73
Manish Kotwani, Vivek Rayadurg, and Bharati A
Echocardiography showed high probability congenital heart disease, dose 7.5 mg hyperbaric bupivacaine combined with fentanyl 50 Tendolkar Anaesthetic. management in a patient of
DORV, ventricular septal defect (VSD) and pulmonary hypertension mcg provide adequate block with minimal systemic side uncorrected double outlet right ventricle emergency
(PH). effects.5 surgery. Indian J Anaesth. 2017 Jan; 61(1): 87–88.