Anaesthetic management of caesarean section in a patient with a permanent pacemaker and severe bilateral ventricular dilatation.

A 33-year-old primigravida presented at 32 weeks gestation with increasing shortness of breath related to left ventricular failure. She had severe bilateral ventricular dilatation of unknown aetiology. An urgent caesarean section was required when she failed to improve on medical therapy, and for this she requested general anaesthesia. The patient had a permanent pacemaker for congenital complete heart block and Harrington rods for kyphoscoliosis. In view of the cardiac problems we transferred the patient to our cardiac unit and performed the procedure with full invasive haemodynamic monitoring. An alfentanil based modified rapid sequence induction resulted in stable maternal haemodynamics. The 2.2 kg male neonate initially required ventilation for 12 h, but then made a good recovery along with his mother.