General anesthesia with remifentanil for cesarean section in a parturient with severe mitral and tricuspid regurgitation

Mitral regurgitation is the second most common valvular heart disease in parturients with significant effects on the mother and the neonate especially after delivery. Regional anesthesia is preferred over general anesthesia for cesarean section due to decreased maternal mortality [1]. However, general anesthesia might be indicated where regional anesthesia is contraindicated or fails or when there is an emergency delivery. Application of systemic opioids is considered to blunt the hemodynamic responses during endotracheal intubation and hormonal stress response during surgery, especially in patients with compromised cardiac function [2-4]. However, they are associated with adverse effects on the neonate and are therefore avoided until after delivery. Remifentanil, an esterase metabolized synthetic opioid, might be an excellent choice for cesarean section under general anesthesia because of its fast onset and extremely short duration. It has been used successfully in the management of high risk parturients requiring cesarean section under general anesthesia [5-9]. We report the use of remifentanil for general anesthesia in a parturient with multiple cardiac lesions including severe mitral regurgitation, tricuspid regurgitation, and pulmonary hypertension requiring cesarean section. Abstract