Low-dose spinal anaesthesia for a parturient with Takayasu's arteritis undergoing emergency caesarean section (original) (raw)
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Spinal Anaesthesia for Caesarean Section in a Patient with Takayasu's Arteritis
2012
Takayasu's Arteritis is a rare, chronic idiopathic occlusive inflammation of the aorta and its major branches. We report a 24 year female, primigravida which was a diagnosed case of Takayasu's Arteritis who underwent an emergency caesarean section under spinal anaesthesia. The uneventful course of anaesthesia in the presented case was related to the through systemic evaluation and careful anaesthetic strategy.
International Journal of Health Sciences and Research, 2016
Takayasu’s arteritis (TA) is a rare, inflammatory panarteritis involving aorta and its major branches. Anesthetic implications of TA include uncontrolled hypertension, end organ dysfunction and difficulty in the monitoring of arterial pressure. We are reporting a case of 30 yr. old parturient having TA with schizophrenia and very bad obstetric history, who was managed in high dependency unit from 24 weeks onward under supervision of multidisciplinary team, as lives of both mother and fetus were at stake. She successfully underwent cesarean section in low dose spinal anesthesia using 7.5mg hyperbaric bupivacaine with 25 mcg fentanyl intrathecally. This report highlights that low dose spinal anesthesia remains a good option if mean arterial pressure is maintained to prevent end organ damage. As the patient remains awake, it allows monitoring of cerebral perfusion without the need of sophisticated cerebral function monitor.
2015
Takayasu's arteritis (TA) is a rare, chronic progressive pan-endarteritis involving the aorta and its main branches. Anaesthesia for patients with TA is complicated by their severe uncontrolled hypertension, end- organ dysfunction. We had a 26 year-old, 94 kg woman married since 6 years with G2 P1IUFD1, with 36.5 weeks of amenorrhoea (by date) and known case of Takayasu's Arteritis with non-functioning left kidney and chronic hypertension admitted for safe confinement. Patient was having pain in abdomen when presented to operation theatre for emergency lower segment caesarean section in view of non-progression of labour. A spinal anaesthesia was given to this patient with 23G Quincke's spinal needle. A spinal level of T6 was achieved and patient got delivered successfully. She was hemodynamically stable throughout the procedure. I. Introduction Takayasu described a rare illness characterized by occlusion of the principal arteries arising from the aortic arch. This diseas...
Anaesthetic management in a parturient with Takayasu arteritis
Egyptian Journal of Anaesthesia, 2012
We report the anaesthetic management of a parturient suffering from Takayasu's arteritis scheduled for elective caesarean section. A full term 29-year-old female weighing 50 kg, height 152 cm, gravida3, para 1 with previous lower segment caesarean section (LSCS) was scheduled for elective LSCS. Patient had suffered a right sided frontoparietal infarct 14 years back for which she underwent treatment in the form of medication from some higher centre She was advised tablet aspirin 75 mg and prednisolone 40 mg once a day. Digital subtraction angiography showed complete occlusion of origin of both subclavian and carotids and reformation of collaterals. Echocardiography revealed mild concentric left ventricular hypertrophy, trivial AR and normal left ventricular systolic function. Caesarean section was planned under regional anaesthesia with monitoring gadgets placed on lower limb. Subarachnoid block (SAB) was administered with 7.5 mg hyperbaric bupivacaine along with 25 lg fentanyl at lumbar 4-5 interspace, using a 25-G Quincke Babcock needle. Intra-operative period was uneventful with minimal fall in blood pressure which was managed accordingly. Parturient was stable in the postoperative period and was moved to a ward after being monitored for 24 h in ICU.
Anesthetic management of Takayasu's arteritis for cesarean section
Takayasu's arteritis (TA), also called pulseless disease, aortic arch syndrome, occlusive thromboaortopathy, or aortic arteritis, is a chronic vasculitis mainly involving the aorta and/ or, its main branches, such as the brachiocephalic, carotid, subclavian, vertebral, renal, coronary and pulmonary arteries. Major challenges for anesthesia in patients with TA involve severe uncontrolled hypertension, end-organ dysfunction, stenosis of major blood vessels, and difficulties in monitoring arterial blood pressure. The cardiovascular complications attributed to the disease can be seriously enhanced during pregnancy. We present successful anesthetic management of emergency cesarean section under general anesthesia in a parturient with long-standing Takayasu's disease with renovascular hypertension complicated by eclampsia.
Successful spinal anaesthesia for caesarean section in an African patient with Takayasu�s arteritis
Pan African Medical Journal, 2018
Takayasu's arteritis (TA) is a rare chronic inflammatory disease affecting mainly the aorta and its main branches. We report a case of a 24-year-old primigravida, an African patient, with TA planned for caesarean section at 37 weeks of gestation. Clinically, she has involvement of aortic arch and its branches and abdominal aorta. She underwent caesarean section and delivered an alive baby boy under successful spinal anaesthesia with insignificant complications. Although it is rare in the African continent, anesthesiologists should be up-to-date with the knowledge of perioperative anesthetic management of TA in pregnant cases requiring operative delivery.
A Case Series of Anesthetic Management of Pregnant Women with Takayasu Arteritis
Medicine Journal, 2019
Takayasu arteritis or pulseless disease (TD) is a chronic progressive inflammatory disease of the aorta and aortic arch branches. It affects females in reproductive years, accounting for almost 80% of the cases. TD complications may affect pregnancy and labor, thus anesthetic and surgical planning are essential during cesarean delivery. The authors report four cases of patients with TD that have undergone cesarean delivery and discuss their anesthetic management. In all cases anesthesia was carried out with neuraxial anesthesia and hemodynamic parameters were kept stable. Although the anesthetic management of TD is not well defined, it is consensual that one of the main objectives of the management of these patients is the maintenance of maternal and fetal tissue perfusion. It is essential to be cautious about the use of drugs that act on vascular tonus, such as oxytocin and vasoconstrictions drugs, because it can result in reduction of systemic vascular resistance and decrease in cardiac output, increase the risks of angiotensin or vasculitis of the central nervous system. In relation to the other transoperative anesthetic care, these are similar to those required for cesarean sections in non-compliant parturients. A regional anesthetic technique allows the monitoring of cerebral function and can be slowly titrated to prevent hemodynamic instability. It is crucial that the anesthesiologist understands the pathophysiology of TD and the pregnancy-induced physiological changes for the safe management of these patients.
Anesthetic Management in a Pregnant Woman with Takayasu Arteritis
The Medical Journal of Okmeydani Training and Research Hospital, 2013
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ANAESTHESIA, PAIN & INTENSIVE CARE, 2018
Takayasu’s arteritis (TA) is a rare, chronic progressive panendarteritis involving the aorta and its main branches, resulting in ischemia and persistent hypertension. Hypertension affects the anesthetic management where the main goal is to control the hemodynamics and prevent end organ damage. We present one case of diagnosed TA with hypertension and multiple cardiac morphological abnormalities posted for total laparoscopic hysterectomy. Key words: Takayasu arteritis; Total laparoscopic hysterectomy Citation: Biswas A, Gupta N, Kaushal S. Anesthetic management of a patient with Takayasu’s arteritis undergoing total laparoscopic hysterectomy. Anaesth Pain & Intensive Care 2018;22(3):374