Anestesi Spinal Dosis Rendah Untuk Pasien Operasi Sesar dengan Stenosis Mitral Berat
Background: Mitral stenosis is a common in pregnancy, where about 25% of patients experience symptoms in the first pregnancy. This is an increase in blood and pulse volume. Some cases of spinal anesthesia are undergoing surgery with abnormalities of mitral stenosis.
Case: 1945,900] 24-year-old primigravida, 32-34 weeks gestation with severe mitral stenosis, mitral regurgitation mild, moderate tricuspid regurgitation, moderate pulmonary regurgitation (EF 62%), moderate pulmonary hypertension (PASP 65 mmHg), stage C heart failure functional class III underwent cesarean section with low dose spinal anesthesia using 5 mg bupivacaine heavy 0.5% and 50 mcg of fentanyl total volume of 2 ml. Spinal block is reached in 5 minutes. Hemodynamics is stable during perioperative. There is no acute heart failure postoperative hemodynamics.  Discussion:  Discussion of the disease in patients with mitral stenosis is to avoid tachycardia, maintain sinus rhythm conditions and aggressively overcome both pharmacological atrial fibrillation and cardioversion especially in patients who are hemodynamically unstable, avoid a decrease in SVR that will increase heart rate so that the work of the heart, avoids hypovolemia, excess fluid, and factors that increase pulmonary arterial pressure such as hypoxia and hypercarbia or pain.  Conclusion: low doses using 5 mg bupivacaine and adjuvant [fentanyl] can be used in cesarean section surgery in patients with severe mitral stenosis due to rapid onset, adequate block levels, stable duration born with good conditions. ]