ANESTHESIA FOR CESAREAN-SECTION IN A MARFAN PATIENT WITH RECURRENT AORTIC DISSECTION

Purpose: We report the anaesthetic management of a 34-yr-old pregnant woman with recurrent aortic disection and Marfan syndrome for Caesarea n section. Clinical features: She presented at 28 wk gestation with re current aortic dissection and had undergone aortic valve replacement a nd coronary ostia reimplantation (Bentall procedure) in the first trim ester of pregnancy. She was treated in hospital with labetalol, antico agulants and steroids and daily echocardiographic examination until 34 wk when caesarean section was planned. After positioning radial arter y and CVP catheters and a transoesophageal echocardiographic probe, ge neral anaesthesia was induced with thiopentone and maintained with iso flurane, and endotracheal intubation was facilitated with vecuronium. The site of incision was infiltrated with lidocaine before surgery whi ch was uneventful. The patient was discharged at 10 days. Conclusions: With appropriate preoperative care and monitoring, uneventful general anaesthesia for: caesarean. section was achieved in a patient with Ma rfan syndrome in the presence of recurrent aortic dissection.