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#35748 Third try is the charm: unanticipated general anaesthesia for C-section in myocarditis
  1. Ana Inês Proença Pinto,
  2. Daniela Cristina Simões Ferreira,
  3. Fernando José Almeida e Cunha and
  4. Teresa Ferreira
  1. Anaesthesiology, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims We present the case of a 39 weeks parturient, scheduled to an elective c-section due to a myocarditis caused by COVID-19 mRNA vaccination.

Methods The myocarditis had developed following her second COVID-19 vaccine during her 29th week of gestation. Her prior history included gestational diabetes, and smoking. She presented with retrosternal pain and nausea, increased troponin, leucocytosis, infra-PR and diffuse ST elevation. Her echocardiogram had an ejection fraction of 55% with apical and inferolateral hypokinesia but the coronarography excluded active coronary disease. She was discharged after 4 days with resolution of symptoms and medicated. After a careful multidisciplinary assessment, an elective c-section at term was decided.

Results Myocarditis following COVID-19 vaccination is a rare complication of mRNA vaccines. Because pregnant people are at increased risk of severe disease and obstetrics complications, their vaccination is considered effective and safe. For parturients with myocarditis, caesarean delivery under epidural anaesthesia is considered to be a safer alternative. It avoids the stress of laryngoscopy, tracheal intubation on a potential difficult airway, and the potential problems of mechanical ventilation. In this case, due to a faulty syringe, we could not estimate how much dose of bupivacaine and sufentanil had been injected to the subarachnoid space. Despite careful administration of epidural ropivacaine, a satisfactory blockade could not be obtained. Carefully titrated general anaesthesia had to be induced to avoid cardiovascular depression. The surgery carried out uneventfully, and a healthy new-born was delivered.

Conclusions This case shows that despite meticulous technique, unsatisfactory blocks can still occur due to material defect.

Attachment Consentimento informado .pdf

  • Myocarditis
  • COVID-19

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