Low dose combined spinal and epidural anaesthesia in a parturient with severe mitral stenosis and severe pulmonary arterial hypertension for Caesarean section

We describe the anaesthetic management for an elective Caesarean section, of a parturient with severe mitral stenosis and severe pulmonary hypertension, using low dose of hyperbaric bupivacaine and for spinal block, supplemented with epidural lignocaine to achieve an adequate level. This patient was vulnerable to develop complications such as hypotension and tachycardia, should conventional regional anaesthesia be employed. This case reports highlights the haemodynamic stability using carefully titrated combined spinal-epidural anaesthesia in a patient with severe mitral stenosis.