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Anaesth. pain intensive care. 2019; 23(3): 274-278

Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for Caesarean Section delivery in patient with maternal heart disease

Dewi Puspitorini Husodo,Isngadi Isngadi,Rudi Hartono,Eka Sunarwidhi Prasedya.


Most of women with cardiovascular diseases show worsen clinical condition during pregnancy. That is caused by cardiovascular physiological changes during pregnancy and increased demand of oxygen-metabolic system. Spinal anesthesia is the most used technique in Section Caesaria (CS) patients, but there are concerns about using spinal anesthesia in patient with cardiac disease due to sudden haemodynamic decrease. Recent studies have proved hemodynamic changes in spinal anesthesia is dose dependent. Decreased dose of spinal anesthesia have potency of inadequate block and change of maternal-fatal haemodynamics due to pain or uncomforted feeling. This could be prevented by using opiod adjuvant that has good effects in anesthesia block. This study is a retrospective study in 33 patients with maternal heart disease undergoing CS under low dose spinal anesthesia in Saiful Anwar Hospital Malang Indonesia from September 2017 until September 2018. The spinal regimen was administered with 5 mg bupivacaine heavy 0.5% combined with 50 mcg fentanyl. We evaluated the hemodynamic preoperative, post injection of spinal anesthetics, post delivery, at the end of surgery. We also evaluated Bromage score, Apgar score of the baby, and relaxation satisfaction from obstetrician. Combination of low dose spinal and opioid for the CS delivery show no significant hypotension effects. Haemodynamic stabilization was achieved prior to injection, post injection, after delivery, post operative as well as in the recovery room. Furthermore, target blocked was reached well in all cases, no significant changes in Apgar score of the baby, and obstetrician satisfied with motoric relaxation. Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0.5% and adjuvant opioid fentanyl 50 mcg can be successfully used for the performance of CS delivery as regards to onset, adequacy, level, duration of the block and hemodynamic stability and good fetal outcome, with impressive cardiovascular stability.

Key words: Anesthesiology, Bupivacaine, Caesarian Section, Fentanyl, Heart disease, Pregnancy

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