Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000300007
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia peridural contínua para cesariana em paciente com arterite de Takayasu: relato de caso

Continuous epidural anesthesia for cesarean section in a patient with Takayasu’s arteritis: case report

Aloísio Cerqueira Buettel; Roberto Monteiro de Castro; Itagyba Martins Miranda Chaves; Luiz Henrique Gonçalves

http://dx.doi.org/10.1590/S0034-70942002000300007 Braz J Anesthesiol, vol.52, n3, p.326-329, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: Anestesia peridural contínua com titulação das doses de anestésico local proporciona eficácia e segurança em pacientes que não toleram flutuações da pressão arterial. O objetivo deste relato é apresentar um caso em que foi utilizada com sucesso anestesia peridural contínua para cesariana em paciente com arterite de Takayasu. RELATO DO CASO: Paciente primigesta, 25 anos, 63 kg, portadora de arterite de Takayasu, com 34-35 semanas de gestação, apresentando sofrimento fetal agudo, PA de 155/85 mmHg, FC de 92 bpm, com ausência de pulsos carotídeos, assim como nos membros superiores e do membro inferior direito. Apresentava apenas pulso poplíteo esquerdo palpável. Foi realizado bloqueio peridural contínuo com doses fracionadas de 25 mg de bupivacaína a 0,5% com epinefrina (1:200.000), a intervalos de 5 em 5 minutos até um total de 100 mg, associando-se 2 mg de morfina e 100 µg de fentanil. CONCLUSÕES: A anestesia peridural contínua com doses tituladas de bupivacaína a 0,5% com epinefrina pode ser utilizada em pacientes com Arterite de Takayasu, tomando-se as medidas de precaução com portadoras dessa doença.

Palavras-chave

ANESTESIA, DOENÇA

Abstract

BACKGROUND AND OBJECTIVES: Continuous epidural anesthesia with titrated doses of local anesthetics is safe and effective for patients not tolerating blood pressure fluctuations. This report aimed at presenting a case in which continuous epidural anesthesia for Cesarean section in a patient with Takayasu’s arteritis was successfully induced. CASE REPORT: Primiparous patient, 25 years old, 63 kg, Takayasu’s arteritis, 34 to 35 weeks of gestation, acute fetal distress, blood pressure = 155/85, HR = 92, no carotid, upper and right lower limb pulse. Patient had only left palpable popliteal pulse. Epidural continuous anesthesia was induced with 25 mg titrated doses of 0.5% bupivacaine with epinephrine (1:200.000), in 5-minute intervals, up to a total dose of 100 mg with 2 mg morphine and 100 µg fentanyl. CONCLUSIONS: Continuous epidural anesthesia with titrated doses of 0.5% bupivacaine may be used in patients with Takayasu’s arteritis, provided all precaution measures are taken with such patients.

Keywords

ANESTHESIA, ANESTHETIC TECHNIQUES, Regional, DISEASE

References

Calich I. Arterite Primária da Aorta Vista pelo Clínico. Doenças da Aorta e Seus Ramos: Diagnóstico e Tratamento. 1991:285-291.

Haimovici H, Mishima Y. Arterite de Takayasu. Cirurgia Vascular: Princípios e Técnicas. 1999:555-580.

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.

Kerr GS. Takayasu’s arteritis. Rheum Dis Clin North. 1995;21:1041-1058.

Schnider SM, Levinson G. Anaesthesia for Obstetrics. 1993.

Ramanathan S, Gupta U, Chalon J. Anesthetic considerations in Takayasu arteritis. Anesth Analg. 1979;58:247-249.

Warner MA, Hugues DR, Messick JM. Anesthetic management of a patient with pulseless disease. Anesth Analg. 1983;62:532-535.

Check TG, Gutsche BB. Maternal Physiology Changes During Pregnancy. Anesthesia for Obstetrics. 1993:3-13.

Fonseca NM, Mandim BLS, Debs YD. Bloqueio peridural para cesariana em paciente com arterite de Takayasu. Rev Bras Anestesiol. 1997;47:435-438.

Johson C, Ransil BJ, Oriol N. Comparison of onset time between 0.5% bupivacaine and 3% 2-chloroprocaine with and without 75 µg fentanyl. Reg Anesth. 1991;16:228-231.

Björnestad E, Smedvig JP, Bjerkreim T. - Epidural ropivacaine 7.5 mg/ml for elective caesarean section: double-blind comparison of efficacy and tolerability with bupivacaine 5 mg/ml. Acta Anaesthesiol Scand. 1999;43:603-608.

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