• Takeru Shimizu, Hiroshi Takahashi, Naoki Matsumiya, Masayuki Miyabe, and Makoto Tanaka.
• Department of Anesthesiology, University of Tsukuba, Tsukuba 305-8575.
• Masui. 2007 Aug 1;56(8):949-52.

AbstractA 31-year-old woman with primary pulmonary hypertension presented for an elective cesarean section at the 34-week gestation. After monitoring pulmonary artery, systemic artery blood pressures and an electrocardiogram, continuous lumbar epidural anesthesia was performed. Uneventful delivery was followed by a sudden decrease in systemic pressure and loss of consciousness. Her trachea was intubated and administration of epinephrine was started. Nitroprusside and milrinone were infused to decrease pulmonary artery pressure and to maintain systemic arterial pressure. However, she died after 16 hours due to an impairment of right ventricular function. Although the patient with PPH had been managed successfully using continuous epidural analgesia until delivery, sudden hemodynamic alterations following delivery could not be controlled by pharmacological interventions.

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