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Anesthesia for cesarean section in a patient with Holt-Oram syndrome.
[holt-oram syndrome]
Holt-
Oram
syndrome
is
a
rare
genetic
disorder
affecting
the
heart
and
upper
limbs
(
atriodigital
dysplasia
)
.
The
manifestations
of
the
limb
defects
may
vary
in
severity
from
subtle
carpal
bone
defects
and
triphalangeal
thumb
to
digit
aplasia
and
upper
extremity
phocomelia
.
Cardiac
abnormalities
include
atrial
and
/
or
ventricular
septal
defects
,
anomalies
in
pulmonary
venous
return
and
various
dysrhythmias
.
We
present
the
anesthetic
management
of
a
parturient
with
this
syndrome
who
underwent
elective
cesarean
section
and
tubal
ligation
,
conducted
under
combined
spinal
-epidural
anesthesia
with
a
low
dose
of
intrathecal
bupivacaine
.
Our
goal
was
to
avoid
an
excessively
high
sympathetic
block
or
excessive
sympathetic
stimulation
accompanied
by
potential
deleterious
effects
on
cardiac
rhythm
.
Cardiac
monitoring
was
continued
in
the
postoperative
period
for
6
h
because
of
the
possibility
of
dysrhythmia
.