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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims IPAH corresponds to sporadic disease without any family history of PH or known triggering factor with mPAP > 25 mm Hg or more at rest after excluding left sided heart disease and certain other disorders[1].Pregnancy in IPAH patients is associated with very high peri-partum mortality and conception is not advised and if detected early in pregnancy, then termination is advised[2].

Methods Parturient,37years,at 35 weeks gestation,in premature labour was referred to us being diagnosed as IPAH;NYHA Class III,on Tab.Sildenafil 12.5mg BD and Inj.Enoxaparin 40mg s.c. Post high risk consent,LSCS done under lumbar epidural anaesthesia with 0.25% Bupivacaine+Fentanyl,with standard monitoring and intra arterial line,maintaining hemodynamic stability.Intra-op BP decreased twice,treated with Phenylephrine 50mcg iv bolus & rest was uneventful.Patient monitored in CCU for 48hours;on continuous epidural 0.125% Bupivacaine infusion,with uneventful post operative period.

Results During pregnancy the circulatory and haematological changes which occur can lead to increased peri-op mortality and morbidity in patients of IPAH.The anaesthetic goals are Maintenance of adequate Systemic Vascular Resistance (SVR);Maintenance of intra-vascular volume and venous return;Avoidance of aorto-caval compression;Prevention of pain, hypoxemia,hypercarbia and acidosis which may increase Pulmonary Vascular Resistance(PVR) and avoidance of myocardial depression.The choice of anaesthesia for LSCS in patients with IPAH is controversial as there is no established anaesthetic protocols to manage such patients and varied reports make it difficult to come to a well-established decision.

Conclusions Epidural anesthesia can be safely administered during LSCS in a selected group of patients with IPAH,using a multi-disciplinary team approach and extreme vigilance leading to a good maternal and fetal outcome.