Use of combined spinal epidural technique with milrinone nebulization in a patient with pulmonary stenosis posted for elective cesarean section – A case report

Anesth Pain Med (Seoul). 2025 Jul;20(3):242-245. doi: 10.17085/apm.25223. Epub 2025 Jul 31.

ABSTRACT

BACKGROUND: Anesthetic management in pregnant women with congenital heart disease is complex due to physiological changes during pregnancy and the specific hemodynamic challenges posed by different cardiac anomalies. A multidisciplinary approach is essential to optimize maternal and fetal outcomes. Pregnancy induces significant cardiovascular changes to meet the increased metabolic demands of the mother and growing fetus. Cardiovascular changes may aggravate the underlying pathology during pregnancy, leading to hemodynamic instability.

CASE: A 27-year-old pregnant woman presented with severe pulmonary stenosis after pulmonary valve balloon dilatation for an elective cesarean section using a combined spinal-epidural technique (CSE) and milrinone nebulization to avoid right ventricular dysfunction.

CONCLUSIONS: CSE reduces the stress response to surgery, minimizes myocardial depression associated with anesthetic drugs, and improves postoperative pain control. Techniques such as milrinone nebulization may help lessen the hemodynamic perturbations associated with auto-transfusion post-delivery.

PMID:40792369 | DOI:10.17085/apm.25223