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©2013 UpToDate ® Print Email The anesthesiologist's considerations when evaluating the cardiac parturient for cesarean delivery Risk consideration Example Possible preferred anesthetic technique• High likelihood of requiring DC cardioversion History of arrhythmias General A drop in SVR could be compromising Cyanotic congenital heart disease General Negative ionotropic effect of general anesthetics could be compromising Markedly impaired cardiac contractility Neuraxial Risk of precipitation of acute pulmonary hypertension crisis from tracheal intubation, inadequate neuromuscular blockade, coughing, etc Pulmonary hypertension Neuraxial Risk of precipitation of acute pulmonary hypertension crisis from a poor regional block Pulmonary hypertension General Thromboembolic risk requiring anticoagulation at time of neuraxial Possibly a mechanical valve General High likelihood of maternal or neonatal death and maternal preference Mother would like to see baby at least once prior to either's demise Neuraxial High likelihood of maternal or neonatal death and maternal preference Severe cyanotic or pulmonary hypertensive crisis from anxiety possible General High likelihood of postoperative controlled ventilation or further invasive treatment Immediate postpartum cardiac procedure to be performed General High likelihood of prolonged and complicated surgery Associated maternal intra-abdominal or pelvic congenital abnormalities General Presence of associated abnormalities effecting the airway Neuraxial Anesthesiologist prefers a particular technique • The patient's complete history and physical exam need to be taken into consideration when choosing an anesthetic. This table of risk factors illustrates how a particular risk may influence an anesthesiologist to choose general over neuraxial anesthesia or vice versa. Data from: Dob, DP, Yentis, SM. Practical management of the parturient with congenital heart disease. In J Obstet Anesth 2006; 15:137.