Conduta anestésica em cesariana em gestante com aneurisma intracraniano não roto

Luciana de Souza Cota Carvalho; Walkiria Wingester Vilas Boas

doi:10.1590/S0034-70942009000600011

Clinical Information

Conduta anestésica em cesariana em gestante com aneurisma intracraniano não roto

Anesthetic conduct in cesarean section in a parturient with unruptured intracranial aneurysm

Luciana de Souza Cota Carvalho; Walkiria Wingester Vilas Boas

http://dx.doi.org/10.1590/S0034-70942009000600011 Braz J Anesthesiol, vol.59, n6, p.746-750, 2009

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Resumo

JUSTIFICATIVA E OBJETIVOS: O manuseio anestésico para cesariana programada em gestante com aneurisma intracraniano não roto é particularmente interessante, pois apresenta diversas particularidades relacionadas às alterações fisiológicas da gestação acrescida dos riscos de ruptura do aneurisma durante o procedimento anestésico. A literatura é escassa nesse assunto, sendo assim importante a divulgação dos casos. RELATO DO CASO: Gestante de termo, 31 anos, com aneurisma intracraniano não roto submetida à cesariana programada sob anestesia peridural simples. O procedimento evoluiu sem intercorrências para mãe e filho. CONCLUSÕES: Recomendações baseadas em evidências para anestesia obstétrica em pacientes portadoras de aneurisma intracraniano não roto não existem. Não há dados experimentais ou clínicos que confirmem ou refutem anestesia geral ou regional nesse contexto. Dessa forma, a decisão de qual técnica utilizar deve ser feita com bases individuais, ponderando os riscos e benefícios de cada procedimento e a experiência do profissional que irá conduzi-la.

Palavras-chave

CIRURGIA, Obstétrica, DOENÇAS, Neurológicas

Abstract

BACKGROUND AND OBJECTIVES: The anesthetic management of a parturient with unruptured intracranial aneurysm scheduled to undergo cesarean section is interesting, since it has several particularities associated with pregnancy-related physiologic changes that are associated with the risk of aneurismal rupture during the anesthetic procedure. Studies on this subject are rare in the literature and, therefore, the dissemination of those cases is important. CASE REPORT: This is a 31-year old female at term with unruptured intracranial aneurysm scheduled for cesarean section under epidural block. The procedure evolved without maternal or fetal intercurrences. CONCLUSIONS: Evidence-based recommendations for obstetric anesthesia in patients with unruptured intracranial aneurysm are lacking. Experimental or clinical data confirming or refuting general anesthesia or regional blocks in this context do not exist. Thus, the decision of which technique should be used is individual, considering the risks and benefits of each procedure and the experience of the anesthesiologist.

Keywords

DISEASES, Neurologicals, SURGERY, Obstetric

References

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Conduta anestésica em cesariana em gestante com aneurisma intracraniano não roto

Anesthetic conduct in cesarean section in a parturient with unruptured intracranial aneurysm

Luciana de Souza Cota Carvalho; Walkiria Wingester Vilas Boas

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