Anestesia em gestante com hipertensão intracraniana por meningite tuberculosa: relato de caso

Vanessa Breitenbach; David Henry Wilson

doi:10.1590/S0034-70942005000100011

Scientific Article

Anestesia em gestante com hipertensão intracraniana por meningite tuberculosa: relato de caso

Anesthesia in pregnant patient with intracranial hypertension due to tuberculous meningitis: case report

Vanessa Breitenbach; David Henry Wilson

http://dx.doi.org/10.1590/S0034-70942005000100011 Braz J Anesthesiol, vol.55, n1, p.90-94, 2005

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JUSTIFICATIVA E OBJETIVOS: Está bem estabelecido que a técnica anestésica de escolha para cesariana eletiva é a anestesia regional. Porém, em gestantes com hipertensão intracraniana e infecção do sistema nervoso central esta técnica deve ser evitada. O objetivo deste artigo é relatar o manejo anestésico de uma gestante, com hipertensão intracraniana secundária à meningite tuberculosa, que foi submetida à cesariana eletiva. RELATO DO CASO: Paciente branca, 32 anos, 60 kg, 1,62 m de estatura, na 36ªsemana de idade gestacional, agendada para interrupção cirúrgica da gestação por apresentar-se tetraparética, com hidrocefalia decorrente de meningite tuberculosa. Escolheu-se a anestesia geral para a cesariana com indução em seqüência rápida e manobra de Sellick para a intubação traqueal. As drogas utilizadas foram tiopental (250 mg), rocurônio (50 mg), fentanil (100 µg) e lidocaína (60 mg) por via venosa. A indução anestésica foi suave e mantida com isoflurano até o início do fechamento da pele da paciente, com mínimas alterações de seus sinais vitais e do recém-nascido, que recebeu índice de Apgar 8 e 9, no 1º e 5º minutos, respectivamente. A paciente despertou precocemente, sem deficits neurológicos adicionais. CONCLUSÕES: A anestesia geral ainda é a técnica anestésica preferida para cesariana em gestantes com hipertensão intracraniana, utilizando-se drogas de meia-vida curta e que tenham mínima interferência na pressão intracraniana e no recém-nascido.

Palavras-chave

ANESTESIA, CIRURGIA, Obstétrica, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: It is a well-established fact today that the technique of choice for elective cesarean delivery is regional anesthesia. However, in patients with intracranial hypertension and central nervous system infection, this technique should be avoided. This paper aimed at reporting the anesthetic management of a pregnant patient with intracranial hypertension due to tuberculous meningitis submitted to elective cesarean delivery. CASE REPORT: Caucasian patient, 32 years old, 1.62 m height and 60 kg weight, in the 36th week of gestational age admitted to the obstetrics unit to have her pregnancy interrupted by cesarean delivery because she had become quadriparetic with hydrocephalus due to tuberculous meningitis. The chosen technique was general anesthesia with rapid sequence induction and Sellick maneuver for intubation. Drugs were intravenous thiopental (250 mg), rocuronium (50 mg), fentanil (100 µg) and lidocaine (60 mg). Anesthetic induction was very smooth, with minor changes in vital signs. Anesthesia was maintained with isoflurane until the beginning of incision suture. The baby was delivered quickly and received an Apgar score of 8 e 9 in the 1st and 5th minutes, respectively, and patient woke up as soon as the procedure ended without any additional neurological deficits. CONCLUSIONS: General anesthesia is still the best anesthetic technique for Cesarean delivery in patients with intracranial hypertension. Choice of drugs should include those with short half-life and with minor effects on intracranial pressure and on the newborn.

Keywords

ANESTHESIA, COMPLICATIONS, SURGERY, Obstetric

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Anestesia em gestante com hipertensão intracraniana por meningite tuberculosa: relato de caso

Anesthesia in pregnant patient with intracranial hypertension due to tuberculous meningitis: case report

Vanessa Breitenbach; David Henry Wilson

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