[Anesthesiology problems in Takayasu's syndrome]

Abstract

Takayasu's disease is a rare form of nonspecific obliterative panarteritis of unknown origin, mainly located at supraaortic, renal, and pulmonary arteries and resulting in multiple stenoses and occlusion of major arteries. Predominantly young women in the first three decades of life are affected. Absence of arm pulses, vascular bruits, and retinopathy are classic symptoms. Another symptom is hypertension of the lower extremities and hypotension of the upper extremities, thus potentially impairing cerebral perfusion. A 25-year-old female patient with a 2-year history of Takayasu's disease presented for therapeutic abortion on the grounds of her medical condition. There were significant stenoses of the left common carotid artery and the internal carotid artery. The left subclavian artery was totally obliterated. The arterial blood supply to the left arm was accomplished by the left vertebral artery via a subclavian steal syndrome. Brachial and radial pulses were absent in both arms. General, spinal or epidural anesthesia can produce arterial hypotension. Blood pressure assessment at the lower extremities does not allow conclusions about perfusion of supraaortic arteries and cerebral perfusion pressure. Thus, a paracervical block was performed; sedation and analgesia were achieved with small doses of midazolam and alfentanil. We planned that if general anesthesia became necessary we would induce anesthesia with etomidate and alfentanil and maintain anesthesia by mask ventilation with nitrous oxide in oxygen and supplementary doses of alfentanil. Invasive monitoring such as arterial or Swan Ganz catheterization, was contraindicated because of the possibility that inflamed vessels would become irritated. Therefore, we only monitored ECG, blood pressure at the leg, ventilation parameters, and oxygen saturation at the ear lobe by pulse oximetry.(ABSTRACT TRUNCATED AT 250 WORDS)