General anesthesia for urgent Caesarean section in a patient with untreated Takayasu’s arteritis

Background: Takayasu’s arteritis (TA) is a rare form of nonspesific obliterative panarteritis, and resulting in multiple stenosis and occlusion of major arteries. Progression of the disease may be marked by aneurysmal dilatation of the affected arteries and may lead to fatal outcome, usually from cerebral ischemia or heart failure. In this case report, we describe a successful episode of anesthesia management with monitoring only mean arterial pressure (MAP) in a parturient affected with untreated TA during an urgent Caesarean section (C/S) under general anesthesia (GA).
Case Report: A 25-yr-old woman with a history of TA, was scheduled for emergency C/S under GA for acute fetal distress without doing any laboratory tests or special procedures for TA. The MAP was measured as 153 mmHg in the operating room. Because of our technical insufficiency, we could not perform any cerebral monitoring. We started intravenous nitroglycerine infusion, and titrated during the intraoperative period in accordance to the MAP values. Peroperative and postoperative periods were uneventful, and she was discharged 5 days post partum.
Conclusions: The case presented in this report suggested that, if the blood pressure of a patient with TA before and during the pregnancy is unknown, MAP could be used as a guide in order to protect the brain during general anesthesia, if there is no possibility of monitoring cerebral hemodynamics.

Keywords: Takayasu arteritis , Cesarean Section, general anaesthesia