Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000100006
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia para cesariana em gestante com hipoplasia de aorta distal: relato de caso

Anesthesia for cesarean section on a pregnant woman with hypoplasia of the distal aorta: case report

Leonardo de Andrade Reis; Guilherme Frederico Ferreira dos Reis; Rodrigo Dias Colombano

http://dx.doi.org/10.1590/S0034-70942008000100006 Braz J Anesthesiol, vol.58, n1, p.45-50, 2008
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Resumo

JUSTIFICATIVA E OBJETIVOS: Anomalias vasculares maternas, potencialmente graves para o feto, podem colocar em risco a perfusão uterina, suscitando cuidados ainda maiores por parte da equipe anestésica. O objetivo deste relato foi mostrar a conduta anestésica para operação cesariana em uma gestante com hipoplasia de aorta distal, logo abaixo da emergência das artérias renais, com estenose da artéria renal e ausência de artérias ilíacas. RELATO DO CASO: Paciente de 30 anos, 54 kg, na segunda gestação com uma cesariana anterior sem intercorrências. Durante a realização de ecografia gestacional na 12ª semana observou-se interrupção da aorta logo abaixo da saída das artérias renais. A paciente foi encaminhada para a realização de cineangiocoronariografia que mostrou hipoplasia da aorta distal abaixo das artérias renais, com ausência das artérias ilíacas. Durante a investigação clínica a paciente mostrou-se assintomática, com exceção de hipertensão arterial e claudicação aos grandes esforços. A paciente foi submetida à anestesia peridural contínua, com titulação da dose anestésica necessária à realização da cesariana. Inicialmente foram injetados 50 mg de bupivacaína a 0,5% sem vasoconstritor e 10 µg de sufentanil. Quinze minutos após, a anestesia foi complementada com mais 25 mg de bupivacaína a 0,5%, o que foi suficiente para atingir adequado nível de bloqueio. A cesariana transcorreu sem intercorrências e a criança nasceu em boas condições clínicas. CONCLUSÕES: O uso de anestesia peridural contínua com doses fracionadas demonstrou ser uma técnica anestésica segura para a realização desse procedimento por reduzir os riscos de hipotensão arterial materna inerente ao bloqueio espinal e também por minimizar a transferência placentária de fármacos, que ocorrem quando do emprego da anestesia geral. A titulação de fármacos através do cateter peridural possibilitou atingir nível anestésico adequado à realização do ato cirúrgico.

Palavras-chave

ANALGÉSICOS, Opióide, ANESTÉSICOS, Local, CIRURGIA, Obstétrica, DOENÇA, Vascular, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Maternal vascular anomalies, potentially severe for the fetus, can jeopardize uterine perfusion, which demands more caution by the anesthesiology team. The objective of this report was to demonstrate the anesthetic conduct for a cesarean section on a pregnant woman with hipoplasia of the distal aorta, just below the renal arteries, with stenosis of the renal artery and absence of the iliac arteries. CASE REPORT: This is a 30-year old patient, weighing 54 kg, on her second pregnancy, with a history of an uncomplicated cesarean section. During the gestational echocardiography on the 12th week, it was observed an interruption of the distal aorta, just below the renal arteries. The patient was referred for coronary angiography, which demonstrated hypoplasia of the distal aorta, just below the renal arteries, and absence of the iliac arteries. During the clinical investigation, the patient remained asymptomatic, except for hypertension and claudication during great efforts. She underwent continuous epidural anesthesia and the dose of the anesthetic was titrated as needed for the cesarean section. Initially, 50 mg of 0.5% bupivacaine without vasoconstrictor and 10 µg of sufentanil were administered. After 15 minutes, anesthesia was complemented with 25 mg of 0.5% bupivacaine, which was enough to achieve an adequate level of blockade. The cesarean section was performed without intercurrences, and the fetus was born in good clinical conditions. CONCLUSION: The use of continuous epidural block in fractionated doses demonstrated to be a safe anesthetic technique for this procedure because it reduces the risks of maternal hypotension, inherent to the spinal block, and also minimized the placentary transference of drugs, which is the case with general anesthesia. Titration of drugs through the epidural catheter allowed reaching an adequate anesthetic level for this type of surgery.

Keywords

ANALGESICS, Opioids, ANESTHETICS, Local, ANESTHETIC TECHNIQUES, Regional, DISEASE, Vascular, SURGERY, Obstetric

Referencias

Issy AM, Rodrigues RC. Fisiologia e Farmacologia da Placenta. Anestesia em Obstetrícia. 2007:17-36.

Yassuda H, Yamashita AM. Complicações em Anestesia Obstétrica. Anestesia em Obstetrícia. 2007:117-138.

Gardner E, Gray DJ, Rahilly RO. Anatomia: Estudo Regional do Corpo Humano. 1988:474.

Lapinsky SE. Cardiopulmonary complications of pregnancy. Crit Care Med. 2005;33:1616-1622.

Ngan Kee WD, Khaw KS, Ng FF. Comparision of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Cesarean section. Br J Anaesth. 2004;92:469-474.

Cooper DW, Carpenter M, Mowbray P. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2002;97:1582-90.

Wright RG, Shnider SM, Levinson G. The effect of maternal administration of ephedrine on fetal heart rate and variability. Obstet Gynecol. 1981;57:734-738.

Tong C, Eisenach JC. The vascular mechanism of ephedrine's beneficial effect on uterine perfusion during pregnancy. Anesthesiology. 1992;76:792-798.

Mercier FJ, Riley ET, Frederickson WL. Phenylephrine added to prophylactic ephedrine infusion during spinal anesthesia for elective cesarean section. Anesthesiology. 2001;95:668-674.

Warwick D, Kee N, Khaw KS. Vasopressor in obstetrics: what should be using?. Curr Opin Anaesthesiol. 2006;19:238-243.

James FM, Greiss FC Jr, Kemp RA. An evaluation of vasopressor therapy for maternal hypotension during spinal anesthesia. Anesthesiology. 1970;33:25-34.

Ngan Kee WD, Lau TK, Khaw KS. Comparison of metaraminol and ephedrine infusion for maintaining arterial pressure during spinal anesthesia for elective cesarean section. Anesthesiology. 2001;95:307-313.

Osibamiro-Sedun A, Johnson C. Cardiac considerations for the obstetric patients. Semin Cardiothorac Vasc Anesth. 2003;7:167-173.

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