A 28-year-old parturient at 39 weeks with severe mitral stenosis (valve area 0.8 cm²) is in early labour and requests analgesia. The preferred technique is:

• A Intravenous fentanyl patient-controlled analgesia
• B Single-shot spinal anaesthesia
• C Combined spinal-epidural with rapid onset
• D Epidural anaesthesia with slow titration ✓

Explanation

In severe mitral stenosis, a sudden decrease in systemic vascular resistance can cause pulmonary oedema and cardiovascular collapse. Epidural anaesthesia with slow titration allows gradual sympathetic blockade and haemodynamic stability. Single-shot spinal or rapid-onset combined spinal-epidural produce abrupt sympathectomy and are hazardous. Intravenous fentanyl PCA provides inadequate pain relief for labour and is not the preferred technique.

Reference: Chestnut's Obstetric Anesthesia, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.