Anesthetic Management for Cesarean Delivery in a Patient With Pulmonary Emboli, Pulmonary Hypertension, and Right Ventricular Failure

The maternal mortality rate for parturients with severe pulmonary hypertension is 30% to 50%. General, epidural, and combined low-dose spinal-epidural anesthesia have been used successfully for cesarean deliveries in patients with pulmonary hypertension. We describe a cesarean delivery performed using an intrathecal catheter in a 25-year-old morbidly obese (body mass index, 82 kg/m) woman (gravida 3, para 2 at 32 weeks of gestation) who had severe pulmonary hypertension, right ventricular failure, pulmonary emboli, and obstructive sleep apnea. We discuss the anesthetic considerations for parturients with severe pulmonary hypertension undergoing cesarean delivery including the selection of anesthetic technique, vasopressors, and uterotonic agents