EPIDURAL VOLUME EXTENSION SALINE TECHNIQUE FOR ANESTHETIC MANAGEMENT OF PERIPARTUM CARDIOMYOPATHY CASES FOR EMERGENCY CAESAREAN SECTION- A CASE SERIES

Peripartum cardiomyopathy (PPCM), a rare condition affecting women in late pregnancy and early puerperium, has high morbidity and mortality. It is characterized by impaired contractility with a low ejection fraction. Compensation occurs through the enlargement of the left ventricle with increasing end-diastolic and stroke volumes. As the compensation of the dilated ventricle fails, it leads to systolic dysfunction, progressing to congestive cardiac failure. Early recognition and aggressive management of these cases in the perioperative period is crucial to improving outcomes of both mother and child. The major anesthetic concern in managing these patients is to avoid myocardial depression and optimize cardiac output, thus maintaining myocardial perfusion with stable intraoperative hemodynamics. Neuraxial anesthesia in these cases, must be balanced with their hemodynamic effects and the ability of the patients to compensate for the physiological strains. Epidural Volume Extension (EVE) – saline technique offers the rapidity and reliability of spinal anesthesia and the flexibility of epidural anesthesia. We present a case series of five patients posted for emergency cesarean section who were managed successfully by the EVE saline technique.