Perioperative management of a caesarean section in a patient with isolated pulmonic stenosis and severe pre-eclampsia

The anaesthetic management of a parturient with isolated pulmonic stenosis and severe pre-eclampsia is particularly challenging. Each of this needs to be evaluated as a separate entity and managed in unison. The challenges that we faced were compounded by the urgent nature of Caesarean section in view of equivocal NST with meconium stained liquor. This provided us with little opportunity to evaluate the present cardiac status and the spectrum of manifestations of pre-eclampsia. Central venous and arterial access was promptly established to enable monitoring of fluid and hemodynamic status peri-operatively. Management of preeclampsia was initiated by the use of intra-venous antihypertensive and magnesium sulphate. General anaesthesia with modified rapid sequence intubation was expeditiously administered and this facilitated early delivery of a healthy neonate. The mother was extubated uneventfully following assessment and optimisation of the cardiac status in the ICU.