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Case Studies | Anaesthesiology | India | Volume 12 Issue 10, October 2023
Challenges and Strategies in Anaesthesia Management for Takayasu Arteritis with Severe Hypertension: A Case Study of a High - Risk Pregnancy
Uzma Shaikh | Jyoti Magar [3] | Shalaka Nellore
Abstract: Takayasu's arteritis (TA) is a rare, chronic progressive pan-endarteritis involving the aorta and its main branches. Anesthesia for patients with TA is complicated by severe uncontrolled hypertension, end-organ dysfunction, stenosis of major blood vessels. We present a 26-year-old woman, a known case of TA since childhood, who underwent coarctoplasty at the age of 13 years for emergency cesarean section. She was a chronic hypertensive, on tablet enalapril. During 1st trimester of pregnancy, she was admitted in view of raised Blood Pressure of 220/110 mmHg, so she was put on high doses of multiple antihypertensive drugs namely tablet Nicardia, Labetalol, Isosorbidedinitrate, Hydralazine, Prazosin, Clonidine and was advised termination of pregnancy but she took discharge against medical advice and came back for delivery at 37 weeks of pregnancy. Rheumatologist had started her on high dose steroids 45 mg and Azathioprine 50 mg. Her MRI angiography showed severe luminal narrowing of entire abdominal aorta, stenosis of celiac artery, proximal SMA and left renal artery stenosis .Her left kidney was small and shrunken. Her 2 D echo showed Hypertensive Heart Disease with concentric Left Ventricular Hypertrophy and grade 2 diastolic dysfunction. She had Cushingoidfacies due to chronic steroids. We successfully managed her under sequential spinal and epidural anesthesia.
Keywords: Takayasu's disease, Hypertension, Anaesthesia, vascular stenosis, emergency LSCS
Edition: Volume 12 Issue 10, October 2023,
Pages: 702 - 704