Anesthetic Management of Cesarean Section for Parturient with Takayasu’s Arteritis

Abstract

Takayasu Arteritis (TA) is a chronic inflammatory vasculitis of unknown origin affecting aorta and its branches. This vasculitis can cause stenosis, occlusion or aneurysm of the artery, which affects organ perfusion by altering regional circulation. It appears to affect predominantly young women. Pregnancy in women with TA does not affect the inflammatory evolution of the disease but increases the risk of exacerbation of a preexisting chronic hypertension especially in women with advanced cardiovascular abnormalities prior to pregnancy due to physiological hemodynamic changes. Vaginal delivery is possible in this population, but cesarean section can be indicated sometimes for non-obstetric reasons due to the effects of the disease. Because of the diversity and variable degrees of organ dysfunction, anesthesia has special implications and the choice of the anesthetic technique is not standardized. We report two cases of parturient with TA in which emergency and elective cesarean sections were practiced under spinal anesthesia and we discuss the anesthetic implications of cesarean section in parturient with TA.

Anaesthetic management of a parturient with Takayasu’s arteritis coming for emergency caesarean section

“…Difficult airway, risk of aspiration with fluctuations in blood pressure during intubation, extubation and lighter planes of anaesthesia can cause problems leading to even cerebral haemorrhage, rupture of aneurysms and cardiac dysfunction in these parturients. 3,8 Our parturient belonged to Type III and Stage I of Takayasu's Arteritis and since she did not give consent for any form of regional anaesthesia, we opted for general anaesthesia as the choice of anaesthetic management. Many authors prefer regional anaesthesia over general anaesthesia as it allows monitoring of brain perfusion through the level of patients consciousness which is lost in general anaesthesia.…”

“…6 Pregnancy in women with Takayasu's arteritis does not affect the inflammatory evolution of the disease but increases the risk of exacerbation of pre-existing chronic hypertension. 3 Thus such parturients need special attention during peripartum period owing to the likelihood of complications such as hypertension, multiple organ dysfunction and stenosis leading to decreased regional blood flow, intra uterine growth retardation (IUGR) and low birth weight. 6 Ideal anaesthetic management of these pregnant mothers with Takayasu's arteritis still poses a stringent challenge to anaesthesiologist.…”