Anesthetic Management of a Parturient Implanted with a Permanent Pacemaker - A Case Report

裝置永久性心臟節律器孕婦之麻醉處理－病例報告

伍乙棠(Yuet-Tong Ng) ； 張木榮(Muk-Wing Cheung) ； 許汝寧(Yu-Ling Hui)

《Acta Anaesthesiologica Sinica》 35卷2期 (1997/06) Pp. 107-111

摘要

At the present time, a patient with a pacemaker who undergoes an anesthesia for a surgical procedure is very common, but a paturient with a permanent pacemaker scheduled for elective cesarean section (c/s) is very rare. Complete heart block in pregnancy is not a common event and it may be congenital or acquired, particularly secondary to cardiac surgery. In normal women, the heart rate is physiologically increased commensurate with need, whereas in a paturient with installment of an implanted fixed rate pacemaker of VVI mode her heart rate cannot accelerate to cope with increased physiological demand because of the fixed pacing rate. For cesarean section, because of destabilized cardiovascular adaptation, an anesthesiologist must focus on detecting the early signs of compromised cardiac output in order to avoid maternal as well as fetal distress. He may run considerable risk to administer general or regional anesthesia to this kind of paturient. We present a case report in managing the paturient installed a with non-rate response type pacemaker undergoing C/S under epidural anesthesia.

關鍵字

Pacemaker: artificial ； Delivery: Cesarean section ； Anesthesia: epidural

並列摘要

台灣地區在短短三十年間，因為外科學及麻醉學術的進步，一些患先天性心臟病的病人術後存活大大的提高，手術後不同程度的神經傳導阻斷也因而出現，永久性心臟節律器之裝置有時是有必要的。醫療工程上的進步也發展出不同用途之心節律器。有報告建議孕婦最好用可變心跳數目心節律器以維持改變的心輸出量。我們在此提出一位置有固定心跳數永久性心節律器的孕婦的臨床麻醉病例報告。

並列關鍵字

節律器：人工 ； 生產：剖腹產 ； 麻醉：硬腦膜外腔