Abstract:

There are numerous case reports describing successful drug or electrical cardioversion for atrial fibrillation in pregnancy, but very few of those cases occur during cesarean delivery. This article introduced a patient with paroxysmal atrial fibrillation since mitral valve replacement thirteen years ago treated in West China Second University Hospital in 2019. During her cesarean section under general anesthesia, atrial fibrillation recurred after the placenta was removed. The anesthesiologist used esmolol and cedilanid to control the ventricular rate, and after the operation, the laryngeal mask was used to replace the tracheal tube to reduce the cardiovascular response to extubation. The sinus rhythm was restored, and the patient passed the recovery period from anesthesia smoothly. We aimed to analyze the success and insufficiency of anesthesia management in this case, and provide a reference for the anesthesia management of cesarean section in pregnant women with high risk of atrial fibrillation. Anesthesia management in this case may have been better if laryngeal mask intubation is used immediately after induction of general anesthesia, cedilanid or electrical cardioversion is applied earlier after the onset of atrial fibrillation, and perioperative monitoring of invasive blood pressure and echocardiography is used.

Key words: Atrial fibrillation, Cesarean section, General anesthesia, Mitral valve replacement

摘要： 药物或电复律成功治疗妊娠期房颤的病例报道很多，但剖宫产期间发生房颤的病例报道极少。本文介绍华西第二医院2019年收治的1例二尖瓣置换术后的阵发性房颤患者，在全身麻醉下行剖宫产，胎盘取出后再发房颤，麻醉医生通过应用艾司洛尔、西地兰等药物控制心室率，术毕使用喉罩替换气管导管降低拔管心血管反应，帮助患者成功恢复窦性心律，平稳度过麻醉苏醒期。我们旨在分析此病例的麻醉管理成功及不足之处，为房颤高风险妊娠妇女的剖宫产麻醉管理提供参考。全身麻醉诱导时即使用喉罩插管、房颤发生后更早使用西地兰或电复律、围术期使用有创血压和心脏超声监测，可能是本病例麻醉管理可改进之处。

关键词: 心房颤动, 剖宫产, 全身麻醉, 二尖瓣置换术