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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Anesthetic Management of a Preterm Parturient with severe Superimposed Preeclampsia and newly diagnosed Wolff-Parkinson-White Syndrome

Abstract Number: T 64
Abstract Type: Case Report/Case Series

Joon H Choi BA, MD1 ; Migdalia Saloum MD2; Liane Germond MD3; Dimitri Kassapidis MD4

Patient ST is 34 year-old G2P0101 woman @26 weeks and 4 days who presented to L&D with complaints of blurry vision, and bilateral eye pain. ST had a history significant for chronic hypertension and previous emergent cesarean section (CSXN) due to severe preeclampsia @28 week’s gestation. On admission, the patient was noted to have a BP >160/100 with urine protein > 30gm. At this point, ST was admitted with the diagnosis of superimposed preeclampsia and started on magnesium therapy, labetolol, nifedipine, and betamethasone. AFter starting magnesium, ST reported atypical sharp chest pain that radiated to the right shoulder and worsened with inspiration. An EKG revealed a previously undiagnosed Wolff-Parkinson-White syndrome (WPW). Cardiac enzymes were negative. An echocardiogram showed mild LVH, normal valves, and EF 75%. Cardiology consult concluded the WPW was asymptomatic. All AV nodal blocking agents, beta-blockers, and calcium channel blockers were discontinued for BP control to prevent prolonging the refractory period of the AV node. ST was started on hydralazine and nitroglycerin for BP control. The patient’s blood pressure improved (BP130/80’s). On hospital day 7, ST left against medical advice and with no medications. ST returned 3 days later with complaints of blurry vision and elevated BP >160/100’s. At this time, ST was taken for emergent CSXN due to severe preeclampsia, non-reassuring fetal heart rate, and transverse lie of the fetus. A combined spinal-epidural (CSE) technique was performed for the CSXN. Using the needle through needle technique, a 27 guage spinal needle was placed through the epidural needle with CSF flow and 1.4ml of 0.75% bupivacaine with 20mcg of fentanyl and 300mcg of duramorph was injected. After the spinal dose, an epidural catheter was placed. After confirming adequate surgical anesthesia with a sensory level to T4, the CSXN was started. Procainamide (17mg/kg IV infusion) was prepared and ready in the OR to acutely treat any arrhythmias (AF) associated with WPW. Procainamide was to chosen to control the AF rate by blocking the accessory pathway.1 Defibrillator pads were readily available to perform cardioversion for arrhythmias associated with any hemodynamic instability. The neonate was delivered with APGARS 6 & 8 without any episodes of arrhythmias or hemodynamic instability.

1.KK Sethi, A Dhall, DS Chadha, et al. WPW and Preexcitation Syndromes. J Assoc Physicians India. 2007 Apr;55 Suppl:10-5

SOAP 2013