Anesthetic management of cesarean section in a patient with Takayasu\u2019s arteritis: a case report

Taichi Ando,Ken Yamaura,Jun Maki,Makoto Sumie,Kazuhiro Shirozu,Katsuyuki Matsushita,Shoichi Sasaki,Miho Yoshimura,Keiko Nobukuni,Midoriko Higashi

doi:10.1186/s40981-021-00494-0

Abstract

BackgroundTakayasu’s arteritis (TA) is a chronic, progressive, inflammatory arteritis. We presented the case of cesarean section in a patient with TA.Case presentationA 31-year-old pregnant woman with TA underwent a planned cesarean section at 34 weeks of pregnancy. She had stenosis of the cerebral and coronary arteries and heart failure due to aortic regurgitation. Spinal anesthesia was performed. In addition to standard monitoring, arterial blood pressure in the dorsalis pedis artery and regional cerebral tissue oxygen saturation were monitored. Intraoperative arterial blood pressure was maintained using continuous infusion of noradrenaline with a careful intermittent bolus infusion of phenylephrine. All the procedures were successfully performed without significant complications.ConclusionsIn a pregnant woman with TA, severe stenosis of the cerebral and coronary arteries, and heart failure due to valvular heart disease, careful anesthetic management by selecting catecholamines and assessing the perfusion pressure for critical organs is important.

Highlights

ConclusionsIn a pregnant woman with Takayasu’s arteritis (TA), severe stenosis of the cerebral and coronary arteries, and heart failure due to valvular heart disease, careful anesthetic management by selecting catecholamines and assessing the perfusion pressure for critical organs is important
Takayasu’s arteritis (TA) is a chronic, progressive, inflammatory arteritis
There are no reports of anesthetic management with spinal anesthesia alone for a cesarean section of patients with cervical vascular lesions, severe aortic regurgitation, and coronary artery stenosis caused by TA (Table 1) [3,4,5,6,7,8,9]

Summary

Conclusions

In anesthetic management of cesarean section in a parturient with TA, anesthesiologists should carefully select the anesthetic method and drug administration while considering oral administration of antiplatelet drugs, heart disease, and maintenance of organ blood flow associated with vascular lesions, followed by the measurement of blood pressure and monitoring.

Background

Discussion