Caesarean section under spinal anesthesia at pregnant with Takayasu's arteritis (case report)

Year 2008, Volume: 39 Issue: 2, 67 - 69, 01.03.2008

Elif Bombacı Gıyasettin Fidan Yasin Ekti Banu Çevik Serkan Çolakoğlu

Abstract

Takayasu's arteritis is a rare, idiopathic and chronic inflammatory disease. Anesthesia for patients with TA is complicated by their severe uncontrolled hypertension and difficulties encountered in monitoring arterial blood pressure. We report the anesthetic management of pregnant woman with Takayasu's arteritis undergoing Caesarean section. 31-yr old, pregnant woman was scheduled for emergency Caesarean delivery when fetal distress and increase of maternal liver enzyms developed. She was diagnosed as TA three years before. Arterial pressure in her right arm was 240/100 mmHg and in left arm was 190/95 mmHg. Her femoral arterial pulsations were palpable poorly. After administration of cristalloid solution for hydration, a spinal block was performed with 10 mg 0.5% bupivacaine spinal. Blood pressure was maintained at preoperative levels throughout the intraoperative period. Apgar scores of the neonate were 7 and 9 at 1 and 5 minute respectively. The postoperative course was uncomplicated and the patient was discharged on the fourth postoperative day.

Keywords

Takayasu Arteritis, Cesarean Section, Anesthesia, Spinal, Pregnancy, Adult, Female

Takayasu arteriti olan gebede spinal anestezi ile sezaryen seksiyo: olgu sunumu

Abstract

Takayasu Arteriti (TA) idiyopatik, nadir görülen kronik, inflamatuvar bir hastalıktır. TA olgularında anestezi, kontrol edilemeyen şiddetli hipertansiyon ve arter basıncının monitörizasyonunda güçlükler nedeniyle komplike bir işlemdir. Bu yazıda Takayasu arteritli, gebenin sezaryen seksiyo girişiminde anestezikyaklaşımımız sunulmuştur. 31 yaşındaki gebe olgu, fetal distres ve annenin karaciğer enzimlerinde yükselme gelişmesi üzerine acil sezaryen seksiyoya alındı. Olgu üç yıl önce TA tanısı almıştı. Sağ kol arter kan basıncı 240 /100 mmHg, sol kol 195/90mmHg idi. Femoral arter pulsasyonları zayıf olarak palpe edilebiliyordu, kristalloid solusyonuyla hidrasyon sağlandıktan sonra % 0.5 bupivakain spinal 10 mg ile spinal blok uygulandı. Operasyon boyunca kan basınçları preoperatif değerlerde seyretti. Yenidoğanın 1. ve 5. dakika apgar skoru 7 ve 9 idi. Postoperatif dönemi sorunsuz geçiren olgu 4. günü taburcu edildi.

Keywords

Takayasu artriti, Sezaryen, Anestezi, spinal, Gebelik, Erişkin, Kadın

References

• 1. Kerr GS. Idiopathic art er itiş of Takayasu (Pulseless disease). Tierney LM, McPhee SJ, Papadakis MA (eds). Current Medical Diagnosis & Treatment. 41st ed. London: Me Graw-Hill, 2002:499
• 2. Hampl KF, Schneider MC, Skarvan K,Bitzer J, Graber J. Spinal anaesthesia in apatient with Takayasu's disease. Br JAnaesth 1994; 72: 129- 132
• 3. Kathirvel S, Chavan S, Arya VK, et al. Anesthetic management of patients with Takayasu's arteritis: a case series and review
• Anesth Analg 2001; 93: 60-65
• 4. McKay RSF, Dillard SR. Management of epidural anaesthesia in apatient with Takayasu's disease. Anesth Analg 1992; 74: 297- 299
• 5. Henderson K, Fludder P. Epidural anaesthesia for caesarean section in a patient with severe Takayasu's disease. Br J Anaesth 1999; 83: 956-959
• 6. Başaranoğlu G, Erden V, Kocabora S ve ark
• Takayasu arteritli bir hastada anestezi yönetimi
• Gülhane Tıp Dergisi, 2005; 47:148-9.