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All Journal Majalah Anestesia & Critical Care (MACC) Jurnal Anestesi dan Terapi Intensif Udayana Jurnal Anestesiologi dan Terapi Intensif
EM, Tjahya Ariyasa
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Health Professions Medicine & Pharmacology Physics

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Graded Epidural Anesthesia with Real-Time Hemodynamic Monitoring for Cesarean Delivery in Severe Mitral Stenosis: A Case Report Kurniady, Stephanie; EM, Tjahya Ariyasa; Putra Pradana, Adinda
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/fefrfk17

Abstract

This case report highlights the successful management of a high-risk obstetric patient with severe rheumatic mitral stenosis (MS) and acute decompensated heart failure (ADHF) using graded epidural anesthesia guided by real-time hemodynamic monitoring. A 34-year-old woman, in her second pregnancy following a previous abortion, presented at 34 weeks and 5 days of gestation with progressive dyspnea and orthopnea. Echocardiography confirmed severe MS accompanied by pulmonary hypertension and preserved left ventricular systolic function. After multidisciplinary optimization, an elective cesarean delivery was performed under graded epidural anesthesia with incremental dosing of lidocaine and ropivacaine. Beat-to-beat cardiac output monitoring using the MostCare™ PRAM (Pressure Recording Analytical Method) system guided vasopressor titration with phenylephrine, maintaining hemodynamic stability. The patient remained hemodynamically stable throughout the intraoperative and postoperative periods, with no pulmonary edema or arrhythmias, and was discharged on postoperative day four. This case demonstrates that graded epidural anesthesia, when combined with advanced hemodynamic monitoring and collaborative care, represents a safe and effective alternative to general anesthesia in parturients with severe valvular heart disease.
Graded Epidural Anesthesia with Real-Time Hemodynamic Monitoring for Cesarean Delivery in Severe Mitral Stenosis: A Case Report Kurniady, Stephanie; EM, Tjahya Ariyasa; Putra Pradana, Adinda
Jurnal Anestesiologi dan Terapi Intensif Vol. 1 No. 3 (2025): JATI Desember 2025
Publisher : Udayana University and Indonesian Society of Anesthesiologists (PERDATIN)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/fefrfk17

Abstract

This case report highlights the successful management of a high-risk obstetric patient with severe rheumatic mitral stenosis (MS) and acute decompensated heart failure (ADHF) using graded epidural anesthesia guided by real-time hemodynamic monitoring. A 34-year-old woman, in her second pregnancy following a previous abortion, presented at 34 weeks and 5 days of gestation with progressive dyspnea and orthopnea. Echocardiography confirmed severe MS accompanied by pulmonary hypertension and preserved left ventricular systolic function. After multidisciplinary optimization, an elective cesarean delivery was performed under graded epidural anesthesia with incremental dosing of lidocaine and ropivacaine. Beat-to-beat cardiac output monitoring using the MostCare™ PRAM (Pressure Recording Analytical Method) system guided vasopressor titration with phenylephrine, maintaining hemodynamic stability. The patient remained hemodynamically stable throughout the intraoperative and postoperative periods, with no pulmonary edema or arrhythmias, and was discharged on postoperative day four. This case demonstrates that graded epidural anesthesia, when combined with advanced hemodynamic monitoring and collaborative care, represents a safe and effective alternative to general anesthesia in parturients with severe valvular heart disease.
Hemodynamic Stability with Intrathecal Prilocaine 2% in Caesarean Section Patient with Ebstein’s Anomaly: A Case Report Rasyid, Rifqi Taufiq; Sudiantara, Putu Herdit; EM, Tjahya Ariyasa; Senapathi, Tjokorda Gde Agung
Majalah Anestesia & Critical Care Vol 44 No 1 (2026): Februari
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v44i1.479

Abstract

Introduction: Ebstein’s anomaly is a rare congenital malformation of the tricuspid valve that predisposes pregnant patients to significant hemodynamic instability due to increased circulating volume, cardiac output, and catecholamine levels during pregnancy. Anesthetic management in this population requires careful maintenance of preload, afterload, and sinus rhythm to avoid worsening right-to-left shunting and arrhythmias. Case Description: A 31-year-old gravida 2 para 1 woman (G2P1001) at 37 weeks of gestation with Ebstein’s anomaly type C and severe tricuspid regurgitation who underwent cesarean section due to fetal distress. Spinal anesthesia was performed using hyperbaric prilocaine 2% (80 mg), followed by bilateral ultrasound-guided transversus abdominis plane block for postoperative analgesia. Throughout the 45-minute procedure, the patient maintained stable hemodynamics without episodes of hypotension or arrhythmias. Postoperative recovery in the Obstetric High Dependency Unit remained uneventful, with consistent vital signs and adequate pain control. A healthy neonate was delivered. Conclusion: This case demonstrates that intrathecal prilocaine 2% can provide effective surgical anesthesia while preserving hemodynamic stability in selected parturients with Ebstein’s anomaly. The pharmacological characteristics of prilocaine, rapid onset, intermediate duration, and a favorable sympathetic profile, make it a potential alternative to longer-acting agents in patients at risk of hemodynamic compromise. Further studies are needed to validate its safety and efficacy in parturients with congenital cardiac disease.
Co-Authors Kurniady, Stephanie Putra Pradana, Adinda Rasyid, Rifqi Taufiq Sudiantara, Putu Herdit Tjokorda Gde Agung Senapathi