| Anestesia epidural para cesárea en una paciente con síndrome de Marfan y ectasia dural. Informe de caso |
Epidural anesthesia for cesarean section in a patient with Marfan syndrome and dural ectasia -A case report.
Kim G, Ko JS, Choi DH.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2011 Mar;60(3):214-6. Epub 2011 Mar 30.
Abstract
Pregnancy is considered a period of high risk for cardiovascular complications in patients with Marfan syndrome. Therefore the choice of anesthetic technique for delivery should be focused on minimizing hemodynamic fluctuations, and preferably provide adequate post-operative pain control. For this purpose, neuraxial blocks, such as spinal or epidural anesthesia, may be deemed a safe option. However, dural ectasia is present in 63-92% of patients with Marfan syndrome, and the increased amount of cerebrospinal fluid volume is thought to be one of main reasons for spinal anesthesia failure. We report herein the peri-operative management of a patient with Marfan syndrome and dural ectasia for cesarean section using epidural anesthesia
http://ekja.org/Synapse/Data/PDFData/0011KJAE/kjae-60-214.pdf |
| Embarazo exitoso en una paciente con hipoxemia severa con proteinosis alveolar pulmonar |
Successful pregnancy in a severely hypoxemic patient with pulmonary alveolar proteinosis.
Belchior I, Cerdeira AS, Santos M, Sousa Braga J, Aragão I, Martins A.
Pneumologia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
Rev Port Pneumol. 2011 May - June;17(3):139-142. Epub 2011 Apr 13.
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by abnormal accumulation of a lipoproteinaceous material in the alveoli, which may lead to respiratory failure and has an associated high risk for infections. The mainstay treatment for PAP is whole lung lavage. A pregnant woman, previously diagnosed with primary PAP, the most common form of PAP, was admitted with dyspnea and worsening respiratory function. In one month period, a whole-lung bronchopulmonary lavage was performed twice, with clinical and functional improvement. Pregnancy was carried to term and a healthy baby was delivered. The mechanisms of respiratory impairment are discussed as well as treatment options and response.
http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90020264&pident_usuario=0&pcontactid=&pident_revista=420&ty=50&accion=L&origen=elsevier&web=www.elsevier.es&lan=en&fichero=320v17n03a90020264pdf001_2.pdf
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| Anestesia para cesárea en presencia de enfermedad cardiaca multivalvular e hipertensión pulmonar severa: reporte de un caso |
Anaesthesia for caesarean section in the presence of multivalvular heart disease and severe pulmonary hypertension: a case report.
Coskun D, Mahli A, Korkmaz S, Demir FS, Inan GK, Erer D, Ozdogan ME.
Department of Anesthesiology, Gazi University Faculty of Medicine, Besevler, Ankara, Turkey.
Cases J. 2009 Dec 22;2:9383.
Abstract
INTRODUCTION: Pulmonary hypertension is a rare condition and in combination with pregnancy, it can result in high maternal mortality. Mitral stenosis is one of the complicated cardiac diseases that may occur during pregnancy. In this report, we describe our management of such a case, which was even more difficult in combination with pulmonary hypertension, mitral stenosis, and aortic and tricuspid valve insufficiency requiring emergency caesarean section under general anaesthesia. CASE PRESENTATION: A 29-year-old primiparae was presented to the anaesthetic department for an urgent caesarean section with a diagnosis of severe pulmonary hypertension in combination with mitral stenosis. The patient was hospitalized prepartum and received oxygen therapy and anticoagulation with heparin. The patient was monitored during labour and delivery with oximetry and arterial and central venous pressure line. Pulmonary arterial lines were not used due to an increased risk and questionable usefulness. Echocardiography revealed a systolic pulmonary arterial pressure of 75 mmHg, and mitral stenosis, aortic and tricuspid valve insufficiency. We decided to proceed under general anaesthesia. Anaesthesia was induced with etomidate, and succinylcholine. Dopamine and nitroglycerin infusion was preoperatively started and infusion was also preoperatively continued. Hemodynamic parameters were stable during delivery. Neonatal weight and apgar score were satisfactory. After the delivery of a healthy baby, oxytocin was administered. Surgery was completed uneventfully. During the postoperative period, the patient received furosemide and morphine. As the arterial blood gas analyses were stable and the chest-ray was normal, the patient was extubated postoperatively in the second hour in ICU. CONCLUSION: Patients with significant multivalvular heart disease require careful preoperative, multidisciplinary assessment and anesthetic planning before delivery in order to optimize cardiac function during the peripartum period and make informed decisions regarding the mode of delivery and anaesthetic technique.
http://www.casesjournal.com/content/pdf/1757-1626-2-9383.pdf
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| Anestesia combinada espinal-peridural para cesárea en un paciente con enfermedad de Moyamoya. Informe de un caso |
Combined spinal-epidural anesthesia for cesarean section in a patient with Moyamoya disease -A case report.
Shim KS, Kim EJ, Lee JH, Lee SG, Ban JS, Min BW.
Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea.
Korean J Anesthesiol. 2010 Dec;59 Suppl:S150-3. Epub 2010 Dec 31.
Abstract
Moyamoya disease is a rare progressive occlusive disease of the internal carotid arteries. We report a case of combined spinal-epidural anesthesia in a patient with Moyamoya disease presenting for Cesarean section. Hypotension associated with spinal anesthesia for Cesarean section is the most common and serious adverse effect despite the use of uterine displacement and volume preload. We continuously infused phenylephrine and ephedrine to prevent hypotension. The intraoperative hemodynamic state was stable. The patient had no significant postoperative complications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030023/pdf/kjae-59-S150.pdf
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