Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.03.027
Brazilian Journal of Anesthesiology
Case Report

The dilemma of choosing obstetrics and anesthesia techniques in a patient with cerebral cavernomatosis: a case report

O dilema da escolha de técnicas obstétricas e anestésicas em paciente com cavernomatose cerebral: relato de caso

Verónica López Pérez, Mercedes Jaro, Jose J. Arcas, Mercedes Del Olmo, Maria Y. Tebar

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Abstract

This report describes the case of a pregnant woman who arrived for preanesthetic assessment of External Cephalic Version (ECV) for fetus in breech presentation and cesarean section in case of ECV failure. Although the technique seems simple, attempts to rotate the fetus can result in elevated intracranial pressure, which might cause malformation bleeding. The most appropriate anesthetic technique in cases of arteriovenous malformations during C-sections has not been determined. Neuroaxial anesthesia is safe only in stable brain cavernomas, but the presence of spinal malformations contraindicates it. Anesthetic goals include stabilizing the blood pressure and reducing the risk of rupture.

Keywords

Cerebral cavernomatosis;  Cesarean section;  External cephalic version;  Obstetric anesthesia

Resumo

Este relato descreve o caso de uma gestante que chegou para avaliação pré-anestésica de versão cefálica externa (VCE) para feto em apresentação pélvica e cesariana em caso de falha de VCE. Embora a técnica pareça simples, tentativas de girar o feto podem resultar em pressão intracraniana elevada, o que pode causar sangramento de malformação. A técnica anestésica mais adequada nos casos de malformações arteriovenosas durante as cesarianas não foi determinada. A anestesia neuroaxial é segura apenas em cavernomas cerebrais estáveis, mas a presença de malformações espinhais a contraindica. Os objetivos anestésicos incluem estabilizar a pressão arterial e reduzir o risco de ruptura.

Palavras-chave

Cavernomatose cerebral; Cesariana; Versão cefálica externa; Anestesia obstétrica

References

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3 B.Y. Ong, J. Littleford, R. Segstro, D. Paetkau, I. Sutton Spinal anaesthesia for Caesarean section in a patient with a cervical arteriovenous malformation Can J Anaesth, 43 (1996), pp. 1052-1058

4 P.K. Sinha, P.K. Neema, R.C. Rathod Anesthesia and intracranial arteriovenous malformation Neurol India, 52 (2004), pp. 163-170

5 C. Vallera, L.O. Choi, C.M. Cha, R.W. Hong Uterotonic medications: oxytocin, methylergonovine, carboprost, misoprostol Anesthesiol Clin, 35 (2017), pp. 207-219
 

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