Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942013000200012
Brazilian Journal of Anesthesiology
Clinical Information

Abordagem anestésica de grávida com malformação arteriovenosa cerebral e hemorragia subaracnoidea durante a gravidez: relato de caso

Anesthetic approach of pregnant woman with cerebral arteriovenous malformation and subarachnoid hemorrhage during pregnancy: case report

Catarina Santos Carvalho; Filipa Resende; Maria João Centeno; Isabel Ribeiro; João Moreira

http://dx.doi.org/10.1590/S0034-70942013000200012 Braz J Anesthesiol, vol.63, n2, p.223-226, 2013
PDF Português
PDF English
Downloads: 0
Views: 801

Resumo

JUSTIFICATIVA E OBJETIVOS: A ocorrência de hemorragia subaracnoidea (HSA) durante a gravidez é rara, sendo que cerca de metade é devida a malformações arteriovenosas (MAV). Os autores descrevem a abordagem anestésica de uma grávida de 39 semanas proposta para cesárea, com história de HSA por MAV às 22 semanas. RELATO DO CASO: Grávida de 39 semanas, saudável previamente à gravidez, com antecedentes de HSA às 22 semanas de gestação, manifestada por cefaleias, vômitos e tonturas, sem perda de consciência ou outros déficits à admissão no serviço de urgência. A ressonância magnética (RM) revelou MAV frontal esquerda. Após curto internamento para estabilização e diagnóstico, decidiu-se manter a gravidez e o seguimento ambulatorial multidisciplinar por neurocirurgia e obstetrícia em consulta de alto risco. Optou-se por fazer cesárea eletiva às 39 semanas sob anestesia peridural lombar. No intraoperatório ocorreu um episódio de hipotensão rapidamente revertida com fenilefrina. O Índice de Apgar do recém-nascido foi de 10/10. O cateter peridural foi usado para analgesia pós-operatória, também sem intercorrências. CONCLUSÕES: São muito raros os casos publicados de abordagem anestésica de grávidas com MAV sintomáticas. Todas as decisões tomadas pela equipe multidisciplinar, desde optar por continuar a gravidez ao momento ideal para intervir na MAV, passando pelo tipo de anestesia e analgesia, foram ponderadas em função do risco de dano cerebral. Do ponto de vista anestésico, os autores enfatizam a necessidade de estabilidade hemodinâmica.

Palavras-chave

CIRURGIA, Cesárea, Neurocirurgia, DOENÇAS, Vascular, Hemorragia Subaracnoidea, Malformações Arteriovenosas Intracranianas

Abstract

BACKGROUND AND OBJECTIVES: Subarachnoid hemorrhage (SAH) during pregnancy is a rare event, and about half the cases are due to arteriovenous malformations (AVM). The authors describe the anesthetic approach of a 39 week pregnant patient scheduled for cesarean section, with a history of SAH due to AVM at 22 week gestation. CASE REPORT: 39 week pregnant patient, healthy prior to pregnancy, with a history of SAH at 22 week gestation, manifested by headache, vomiting, and dizziness without loss of consciousness or other deficits on admission to the emergency room. Magnetic resonance imaging (MRI) revealed a left frontal AVM. After a short hospital stay for stabilization and diagnosis, the final medical decision was to maintain the pregnancy and a multidisciplinary follow-up by neurosurgery and high-risk obstetric consultation. An elective cesarean section was performed at 39 weeks under epidural anesthesia. During the intraoperative period, an episode of hypotension rapidly reversed with phenylephrine occurred. The newborn Apgar score was 10/10. An epidural catheter was used for postoperative analgesia, also uneventful. CONCLUSIONS: There are very few published cases of anesthetic approach for pregnant women with symptomatic AVM. All decisions made by the multidisciplinary team, from choosing to continue the pregnancy to the ideal time for AVM intervention and type of anesthesia and analgesia, were weighted according to the risk of brain damage. Regarding the anesthetic procedure, the authors emphasize the need for hemodynamic stability.

Keywords

Intracranial Arteriovenous malformation, Cesarean Section, Neurosurgery: Subarachnoid Hemorrhage

References

Trivedi RA, Kirkpatrick PJ. Arteriovenous malformations of the cerebral circulation that rupture in pregnancy.. J Obstet Gynaecol. 2003;23(5):484-489.

Soderman M, Andersson T, Karlsson B. Management of patients with brain arteriovenous malformations. Eur J Radiol. 2003;46:195-205.

Ogilvy CS, Stieg PE, Awad I. Recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association.. Stroke. 2001;32:1458-1471.

Friedlander RM. Arteriovenous malformations of the brain. N Engl J Med. 2007;356:2704-2712.

Di Rocco C, Tamburrini G, Rollo M. Cerebral arteriovenous malformations in children. Acta Neurochir. 2000;142:145-146.

Sinha PK, Neema PK, Rathold RC. Anesthesia of intracranial arteriovenous malformations. Neurol India. 2004;52(2):163-169.

Newfield P, Cottrell J. Handbook of Neuroanesthesia. 2007:278-295.

Le LT, Wendling A. Anesthetic management of cesarean section in a patient with rupture of a cerebellar arteriovenous malformation. J Clin Anesth. 2009;21(2):143-148.

Horton JC, Chambers WA, Lyons SL. Pregnancy and the risk of haemorrhage from cerebral arteriovenous malformations. Neurosurgery. 1990;27(6):867-872.

Coskun D, Mahli A, Yilmaz Z. Anaesthetic management of caesarean section of a pregnant woman with cerebral arteriovenous malformation: a case report. Cases J. 2008;1:327-329.

Lanzino G, Jensen ME, Cappelletto B. Arteriovenous malformations that rupture during pregnancy: a management dilemma. Acta Neurochir. 1994;126:102-106.

Lynch J C, Andrade R, Pereira C. Hemorragia intracraniana na gravidez e puerpério: Experiência com 15 anos. Arq Neuropsiquiatr. 2002;60(2A):264-268.

Robinson JL, Hall CS, Sedzimir CB. Arteriovenous malformations, aneurysms and pregnancy. J Neurosurg. 1974;41:63-70.

Dias MS, Sekhar LN. Intracranial haemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium. Neurosurgery. 1990;27(855):444-446.

Ng K, Parsons J, Cyna AM. Spinal versus epidural anaesthesia for caesarean section. Cochrane Database Syst Rev. 2004.

Wong C. Spinal and epidural anesthesia. 2007:281-304.

Langesaeter E, Dyer RA. Maternal haemodynamic changes during spinal anaesthesia for caesarean section. Curr Opin Anesthesiol. 2011;24:242-248.

5dd42d7a0e8825f930c63493 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections