British journal of anaesthesia
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Case Reports
Anaesthetic management of a parturient with pulmonary stenosis and aortic incompetence for Caesarean section.
Anaesthetic management of Caesarean section in a parturient with severe pulmonary stenosis and aortic regurgitation is described. The valvular sequelae resulted from previous unsuccessful surgical correction (Ross procedure) of congenital aortic stenosis. This case demonstrates the importance of multi-disciplinary assessment and careful anaesthetic planning, to avoid deterioration in perioperative cardiac performance in parturients with complex valvular disease.
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Many anaesthetists are deterred from using total i.v. anaesthesia because of uncertainty over the concentration of propofol required to prevent awareness. We predicted blood and effect-site concentrations of propofol at two clinical end-points: loss of consciousness and no response to a painful stimulus. ⋯ Unconsciousness and lack of response to a painful stimulus occur within a defined range of effect-site concentrations, predicted by Diprifusor TCI software.