EPIDURALNA ANESTEZIJA ZA CARSKI REZ U BOLESNICE S ARTERIOVENSKOM MALFORMACIJOM MOZGA – PRIKAZ BOLESNICE

Katarina Kličan-Jaić, Iva Pažur, Jasna Martinčević, Vladimir Kalousek, Vesnica Košec

Cilj nam je bio pokazati da se carski rez može uspješno izvesti u epiduralnoj anesteziji kod trudnice s arteriovenskom malformacijom (AVM). Intrakranijalne arteriovenske malformacije rijetko se viđaju u trudnoći. Završetak trudnoće carskim rezom izazov je za anesteziologa koji se skrbi za takve trudnice. Važno je razumjeti hemodinamske promjene koje se događaju u trudnoći i moždanu fiziologiju kao preduvjete za uspješno izvođenje anestezioloških postupaka i izbjegavanje mogućih komplikacija. Radi se o prikazu tridesetdvogodišnje trudnice s arteriovenskom malformacijom V. stupnja prema Spetzler-Martinovoj klasifikaciji. Primljena je u bolnicu zbog pogoršanja neurološkog statusa s ataksijom kao glavnim simptomom. Uzimajući u obzir njezin neurološki status i progresiju opstetričkog nalaza, odlučili smo završiti trudnoću carskim rezom u epiduralnoj anesteziji. Literaturni podaci o anesteziološkom zbrinjavanju trudnice s intrakranijalnom arteriovenskom malformacijom malobrojni su i kontradiktorni. Uspoređujući opću i spinalnu anesteziju s epiduralnom, smatrali smo da je epiduralna anestezija u ovom slučaju bolji izbor. Hemodinamska i respiratorna stabilnost majke i djeteta bile su održane tijekom operacije i u postpartalnom periodu. Nije bilo znakova pogoršanja majčina neurološkog statusa. Držimo da se carski rez kod trudnice s arteriovenskom malformacijom može sigurno izvesti u epiduralnoj anesteziji.

Our goal was to demonstrate that cesarean section in a pregnant woman with arteriovenous malformation (AVM) can be successfully performed under epidural anesthesia. Intracranial arteriovenous malformations are rarely encountered in pregnancy. Completion of pregnancy by cesarean section imposes a great challenge for anesthesiologist taking care of these parturients. It is essential to understand hemodynamical changes during pregnancy and cerebral physiology in order to optimise anesthetic management and avoid possible complications. We report a case of a 32-year-old pregnant woman with arteriovenous malformation grade V according to Spetzler-Martin classification. She was admitted to hospital due to deterioration in her neurological status with ataxia as the leading symptom. Considering her neurological status and progression of obstetrical finding it was decided to complete the pregnancy by cesarean section under epidural anesthesia. The literature data about anesthetic management of parturients with intracranial AVM undergoing cesarean section are scarce and conflicting. In comparison with general and spinal anesthesia epidural anesthesia was considered as a better choice in this case. Hemodynamic and respiratory stability of mother and infant was maintained throughout the operation and in postpartal period. There were no signs of deterioration in maternal neurological status. Cesarean section in a woman with AVM grade V can be safely performed under epidural anesthesia.