A Case Series of Anesthetic Management of Pregnant Women with Takayasu Arteritis
[1]
Marilia da Silva Faria de Macedo, Department of Anesthesia, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.
[2]
Alex Pinto de Macêdo da Silva, Department of Anesthesia, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.
[3]
Maurício Goldberg Neto, Department of Anesthesia, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.
[4]
Marcos Lopes de Miranda, Department of Anesthesia, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.
[5]
Carlos Darcy Alves Bersot, Department of Anesthesia, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.
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, Takayasu Arteritis, Cesarean Delivery
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