title: Combined Spinal-Epidural for Vaginal Delivery in a Parturient With Takayasu's Arteritis.
abstract: Takayasu's arteritis is a rare, progressive panendarteritis involving all layers of the arterial wall. This disease includes variable involvement of the aorta and its major branches. The most common complication with this condition is severe, uncontrolled hypertension, often leading to end organ dysfunction. We describe the management of a 27-year-old woman diagnosed with Takayasu's arteritis that presented in labor with intense pain and underwent a combined spinal-epidural for anesthetic management. Per literature review, a combined spinal-epidural technique for planned vaginal delivery has not been described for a laboring Takayasu patient. Our technique, utilizing intrathecal opioids and a low-dose local anesthetic-opioid epidural infusion, provided adequate analgesia while maintaining hemodynamic stability throughout labor augmentation and successful vaginal delivery.
authors.affiliation: University of Louisville Hospital, Louisville, KY, USA.
authors.forename: Sean Patrick
authors.initials: SP
authors.lastname: Clifford
authors.affiliation: Deaconess Hospital, Evansville, IN, USA.
authors.forename: Paul Brian
authors.initials: PB
authors.lastname: Mick
authors.affiliation: The Pain Institute, Louisville, KY, USA.
authors.forename: Brian Matthew
authors.initials: BM
authors.lastname: Derhake
keywords: Takayasu’s arteritis; combined spinal-epidural; labor pain