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BJA Advance Access published online on May 12, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael105
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted March 13, 2006

Case Report

Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report

W. L. Corbett 1, C. M. Reiter 1, J. R. Schultz 1, R. J. Kanter 2, and A. S. Habib 1 *

1 Department of Anaesthesiology, Box 3094, USA
2 Department of Paediatric Cardiology, Duke University Medical Center, Durham, NC 27710, USA

* To whom correspondence should be addressed.
A. S. Habib, E-mail: habib001{at}mc.duke.edu


  Abstract

Postural orthostatic tachycardia syndrome encompasses a group of disorders characterized by orthostatic intolerance. We describe the anaesthetic management of analgesia for labour and of Caesarean section in a parturient suffering from this disorder. Worsening of her symptoms during pregnancy was managed with an increase in the dose of {beta}-blockers taken by the patient. Epidural analgesia was instigated early to attenuate the stress of labour and avoid consequent triggering of a tachycardic response. Slow titration of epidural analgesia and anaesthesia after an adequate fluid preload was undertaken to minimize hypotension and subsequent tachycardia. Neuraxial opioid, combined with non-steroidal anti-inflammatory drugs and bilateral iliohypogastric and ilioinguinal nerve blocks were used to optimize postoperative analgesia.

Keywords: anaesthesia, obstetric, Caesarean section; anaesthetic techniques, epidural; complications, labour; complications, postural orthostatic tachycardia syndrome.
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E-letters:

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Preloading: lots for POTS?
Sukanya Mitra, et al.
British Journal of Anaesthesia, 4 Oct 2006 [Full text]
Re: Preloading: lots for POTS?
Ashraf S Habib
British Journal of Anaesthesia, 3 Nov 2006 [Full text]

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