Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000400010
Brazilian Journal of Anesthesiology
Clinical Information

Arterite de Takayasu na gestação: relato de caso e revisão de literatura

Takayasus's arteritis in pregnancy: case report and literature review

Plínio da Cunha Leal; Fernanda Fabrízia Martins Silveira; Eduardo Jun Sadatsune; Jefferson Clivatti; Américo Masafuni Yamashita

http://dx.doi.org/10.1590/S0034-70942011000400010 Braz J Anesthesiol, vol.61, n4, p.482-485, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: A Arterite de Takayasu (AT) é uma doença idiopática, crônica, inflamatória e progressiva que causa estreitamento, oclusão e aneurismas das artérias sistêmicas e pulmonares, afetando principalmente a aorta e seus ramos. Durante a gestação deve-se estar atento à condução dessas pacientes. O objetivo foi relatar um caso de condução anestésica periparto de uma paciente com AT e fazer uma revisão da literatura. RELATO DE CASO: Gestante de 31 anos com troca de arco aórtico e prótese metálica em válvula aórtica por AT há 4 anos. A gestação prosseguiu sem complicações e a paciente foi internada com 34 semanas para adequação da anticoagulação. Realizou-se cesariana eletiva com 39 semanas de gestação com anestesia peridural contínua. Doses fracionadas de anestésico local foram administradas para garantir a instalação lenta do bloqueio. Paciente permaneceu estável hemodinamicamente e foi encaminhada para pós-operatório na UTI. CONCLUSÕES: Muitas complicações podem ocorrer na gestante com AT. Avaliação cuidadosa da paciente, tratamento das complicações da AT e planejamento anestésico cirúrgico são fundamentais. Manutenção da perfusão orgânica é a principal preocupação nessas pacientes e bloqueios neuroaxiais podem ser utilizados sem prejuízo para mãe ou recém-nato. Na paciente com as complicações da AT compensadas, a monitoração não difere da utilizada rotineiramente em cesarianas. Anestesia peridural contínua de instalação lenta mantém a estabilidade hemodinâmica e permite monitorar a perfusão cerebral através do nível de consciência da gestante. Para evitar hipoperfusão orgânica ou complicações hipertensivas no pós-operatório, a paciente deve permanecer monitorada em unidade intensiva ou semi-intensiva por 24 horas.

Palavras-chave

ANESTESIA, CIRURGIA, DOENÇAS, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Takayasus's Arteritis (TA) is a chronic, inflammatory, progressive, idiopathic disease that causes narrowing, occlusion, and aneurysms of systemic and pulmonary arteries affecting especially the aorta and its branches. During pregnancy, one should pay special attention to these patients. The objective of this report was to present the peripartum anesthetic care of a patient with TA and a review of the literature. CASE REPORT: This is a 31-year old gravida who underwent exchange of the aortic arch and placement of a metallic aortic valve for TA four years ago. She had no complications during pregnancy, and she was admitted at 34 weeks of pregnancy for anticoagulation management. Elective cesarean section was performed at 39 weeks with continuous epidural anesthesia. Fractionated doses of local anesthetic were administered to guarantee slow installation of the blockade. The patient remained hemodynamically stable and was transferred to the ICU in the postoperative period. CONCLUSIONS: Several complications can affect gravidas with TA. Careful patient evaluation, treatment of TA complications, and anesthetic-surgical planning are fundamental. Maintenance of perfusion is the main concern in these patients, and neuraxial blocks may be used without harming the mother and fetus. In patients with compensated TA complications, monitoring does not differ from that routinely used in cesarean sections. Continuous epidural anesthesia with slow installation maintains hemodynamic stability and allows monitoring cerebral perfusion through the level of consciousness. To avoid postoperative hypoperfusion or hypertensive complications patients should be monitored in an intensive or semi-intensive care unit for 24 hours.

Keywords

Takayasu Arteritis, Anesthesia, Cesarean Section, Heart Valve Diseases

Referencias

Beilin Y, Bernstein H. Successful epidural anaesthesia for a patient with Takayasu's arteritis presenting for Caesarean section. Can J Anaesth. 1993;40:64-66.

Ishikawa K, Matsumura S. Occlusive thromboaortopathy (Takayasu's disease) and pregnancy: Clinical course and management of 33 pregnancies and deliveries. Am J Cardiol. 1982;50:1293-1300.

Ioscovich A, Gislason R, Fadeev A. Peripartum anesthetic management of patients with Takayasu's arteritis: case series and review. Int J Obstet Anesth. 2008;17:358-364.

Kathirvel S, Chavan S, Arya VK. Anesthetic management of patients with Takayasu's arteritis: a case series and review. Anesth Analg. 2001;93:60-65.

Matsumura A, Moriwaki R, Numano F. Pregnancy in Takayasu arteritis from the view of internal medicine. Heart Vessels. 1992;7(^sSuppl):120-124.

Domingo RT, Maramba TP, Torres LF. Acquired aorto-arteritis: A worldwide vascular entity. Arch Surg. 1967;95:780-790.

Wilke WS. Large vessel vasculitis (giant cell arteritis, Takayasu arteritis). Baillieres Clin Rheumatol. 1997;11:285-313.

Lupi-Herrera E, Sanchez-Torres G, Marcushamer J. Takayasu's arteritis: Clinical study of 107 cases. Am Heart J. 1977;93:94-103.

Ishikawa K. Natural history and classification of occlusive thromboaortopathy (Takayasu's disease). Circulation. 1978;57:27-35.

Mahmood T, Dewart PJ, Ralston AJ. Three successive pregnancies in a patient with Takayasu's arteritis. J Obstet Gynaecol. 1997;17:52-54.

Sharma BK, Sagar S, Singh AP. Takayasu arteritis in India. Heart Vessels. 1992;7(^ssuppl):37-43.

Kerr GS, Hallahan CW, Giordano J. Takayasu arteritis. Ann Intern Med. 1994;120:919-929.

Liang P, Hoffman GS. Advances in the medical and surgical treatment of Takayasu arteritis. Curr Opin Rheumatol. 2005;17:16-24.

Salem M, Tainsh RE Jr, Bromberg J. Perioperative glucocorticoid coverage: A reassessment 42 years after emergence of a problem. Ann Surg. 1994;219:416-425.

Coursin DB, Wood KE. Corticosteroid supplementation for adrenal insufficiency. JAMA. 2002;287:236-240.

Wong VC, Wang RY, Tse TF. Pregnancy and Takayasu's disease. Am J Med. 1983;75:597-601.

Henderson K, Fludder P. Epidural anaesthesia for caesarean section in a patient with severe Takayasu's disease. Br J Anaesth. 1999;83:956-959.

Choi DH, Kim JA, Chung IS. Comparison of combined spinal epidural anesthesia and epidural anesthesia for caesarean section. Acta Anaesthesiol Scand. 2000;44:214-219.

Banerjee A, Stocche RM, Angle P. Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis. Can J Anaesth. 2009;57:24-31.

Hauth JC, Cunningham FG, Young BK. Takayasu's syndrome in pregnancy. Obstet Gynecol. 1977;50:373-375.

Thornton P, Douglas J. Coagulation in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2010;24:339-352.

Clark AG, al-Qatari M. Anaesthesia for Caesarean section in Takayasu's disease. Can J Anaesth. 1998;45:377-379.

Kawaguchi M, Ohsumi H, Nakajima T. Intra-operative monitoring of cerebral haemodynamics in a patient with Takayasu's arteritis. Anaesthesia. 1993;48:496-498.

Fawcett WJ, Razis PA, Berwick EP. Post-operative cerebral infarction and Takayasu's disease. Eur J Anaesthesiol. 1993;10:33-35.

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