Combined spinal-epidural anesthesia for Cesarean section in a patient withperipartum dilated cardiomyopathy

Purpose: To report a case of peripartum dilated cardiomyopathy associated w ith morbid obesity and possible difficult airway presenting for elective Ce sarean section, which was successfully managed with combined spinal-epidura l anesthesia. Clinical features: A morbidly obese parturient with a potentially difficult airway, suffering from idiopathic peripartum cardiomyopathy (ejection frac tion 20%), was scheduled for an elective Cesarean section. A combined spina l epidural anesthesia was performed and 6 mg of bupivacaine were injected i nto the subarachnoid space. This was supplemented after 60 min with 25 mg o f bupivacaine injected epidurally. The patient's hemodynamic status was mon itored with direct intra-arterial blood pressure and central venous pressur e measurements. The patient's perioperative course was uneventful. Conclusion: In patients suffering from peripartum cardiomyopathy, undergoin g Cesarean section, combined spinal-epidural anesthesia may be an acceptabl e anesthetic alternative.