title: [Urgent cesarean section under combined spinal and epidural anesthesia in a patient with aortitis syndrome].
abstract: We report the anesthetic management of a patient with aortitis syndrome using combined spinal and epidural anesthesia. A 28-year-old gravida with aortitis syndrome accompanied by faints was scheduled for an urgent cesarean section. Combined spinal and epidural anesthesia was thought to be better for this case in order to monitor the cerebral circulation by her consciousness level and to reduce the hemodynamic change during surgery as compared to spinal or epidural anesthesia alone. After inserting an epidural catheter at the Th 12/L 1 interspace, spinal anesthesia was performed with 1.5 ml of 0.3% dibucaine at the L 4/L 5 interspace. The level of analgesia was under L 1 with the pinprick method 10 min after the spinal anesthesia. Next, 5 ml of 1.5% mepivacaine was injected through the epidural catheter. The level of analgesia reached to Th 6 without major hemodynamic changes. A healthy 2740 g infant was delivered and she had an uneventful recovery. We conclude that combined spinal and epidural anesthesia is useful in a patient with aortitis syndrome undergoing an urgent cesarean section in order to monitor the cerebral circulation by the consciousness level and to reduce the hemodynamic change.
authors.affiliation: First Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi.
authors.forename: S
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: M
authors.initials: M
authors.lastname: Nagao
authors.forename: M
authors.initials: M
authors.lastname: Mishio
authors.forename: T
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Y
authors.initials: Y
authors.lastname: Okuda
authors.forename: T
authors.initials: T
authors.lastname: Kitajima
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D001015:Aortic Arch Syndromes; D002560:Cerebrovascular Circulation; D002585:Cesarean Section; D003243:Consciousness; D004630:Emergencies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D016343:Monitoring, Intraoperative; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular