# Anesthesia management for cesarean section in a woman with chronic renal failure and heart failure: a case report

## TL;DR

A woman with chronic kidney and heart failure safely underwent a cesarean section using a combination of spinal and epidural anesthesia.

## Contribution

This case report presents a rare and successful use of combined spinal-epidural anesthesia for cesarean section in a patient with severe comorbidities.

## Key findings

- Combined spinal and epidural anesthesia was safely used for cesarean section in a woman with chronic renal and heart failure.
- The patient's hemodynamic and respiratory status remained stable throughout and after the procedure.
- Changing anticoagulant from heparin to nafamostat helped prepare for the surgery without complications.

## Abstract

Pregnancy in a woman with heart and chronic renal failure can lead to life-threatening complications for both mother and child. Although such cases are often delivered by cesarean section, few reports have described anesthesia methods.

We encountered a case in which cesarean section was performed using combined spinal and epidural anesthesia for a pregnant woman with chronic renal and heart failure. The 35-year-old Japanese woman had been undergoing hemodialysis for several years. Heart failure symptoms that appeared during pregnancy initially improved with treatments such as increasing hemodialysis, but recurred. She was admitted to the intensive care unit. The initial plan was to deliver the baby after a few weeks, but further progression of heart failure became a concern. After a clinical conference among staff, a cesarean section with combined spinal and epidural anesthesia was scheduled for 24 weeks, 0 days of gestation. The anticoagulant for dialysis was also changed from heparin to nafamostat in preparation for cesarean section. Monitoring was started with central venous and radial artery pressures before induction of anesthesia. Combined spinal and epidural anesthesia was induced and the cesarean section was completed without complications. Surgery was initiated under continuous administration of phenylephrine, which was intended to avoid hypotension due to anesthesia. The hemodynamic and respiratory status of the patient remained stable postoperatively. After the cesarean section, morphine was administered epidurally and the epidural catheter was removed.

Cesarean section was safely performed for a pregnant woman with renal and heart failure using combined spinal and epidural anesthesia.