Problem-Based Learning Discussion on Neuraxial Anesthesia in Parturients With Repaired Tetralogy of Fallot

Approximately 1% of all children born in the United States suffer from congenital heart disease, and 25% of those affected are born with critical congenital heart disease requiring surgical intervention. Advances in cardiac surgery have allowed an increasing number of patients with complex congenital heart disease to live into adulthood. It is important that anesthesiologists understand the particularities of providing safe clinical care for these patients in different situations.

This problem-based learning discussion (PBLD) was created to expose medical students, anesthesiology residents, and anesthesiology faculty members to potential clinical situations involving the management of an adult parturient with a repaired tetralogy of Fallot defect who is in labor. The discussion focuses on reviewing and reinforcing an understanding of the clinical implications of the defect before and after repair, as well as the specific anesthetic considerations with regard to these patients.

This PBLD has been delivered on two separate occasions to a number of faculty members (N = 10), resident physicians (N = 12), a medical student (N = 1), and nurse anesthetists (N = 2) within our institution. It has been very well received and has stimulated discussion surrounding care for an adult parturient with a complex cardiac history within our facility. The exercise was evaluated anonymously by all participants and has been very positively reviewed.

We are confident that this PBLD, after significant efforts, has become a substantial and informative learning tool for medical students, anesthesiology residents, nurse anesthetists, and faculty alike.