What are the special considerations for anesthetic management of labor and delivery in a patient with HOCM?

What are the special considerations for anesthetic management of labor and delivery in a patient with HOCM?

Anesthesia management for labor and delivery in the parturient with HOCM is quite complex. β-Adrenergic blocker therapy may have been discontinued during pregnancy because of the association with fetal bradycardia and intrauterine growth retardation. Spinal and epidural anesthesia are relatively contraindicated because of the associated vasodilation. If hypotension occurs during anesthesia, the use of β-adrenergic agonists, such as ephedrine, may result in worsening outflow tract obstruc-tion, whereas α-adrenergic agonists, such as phenyl-ephrine, may result in uterine vasoconstriction and fetal asphyxia. The successful management of cesarean section with both general and epidural anesthetics has been reported. However, careful titration of anesthetic agents and adequate volume-loading (guided by invasive moni-toring) is essential to the safe conduct of anesthesia in this clinical setting.