Sistemik lupus eritematozusu olan bir gebede anestezik yaklaşım

Sistemik lupus eritematozus (SLE) sebebi belli olmayan, öncelikle 20-50 yaşlar arası bayanları olmak üzere tüm yaş gruplarını etkileyen otoimmün bağ dokusu hastalığıdır. Bu olgu sunumu ile makat geliş nedeniyle acil olarak sezaryen endikasyonu konan SLE’li bir gebedeki anestezi deneyimimizi aktarmayı amaçladık. Rutin monitörizasyonu takiben hastaya spinal anestezi uygulandı. Perioperatif olarak anne veya bebekle ilgili herhangi bir sorun yaşanmadı. Yenidoğanın fizik muayene ve elektrokardiyografisi normaldi. Hasta ve bebek postoperatif 3. günde taburcu edildi. İyi bir preoperatif değerlendirme ve postoperatif yenidoğan bakımıyla ve ilgili şartların sağlanmasıyla SLE’li hastalarda sezaryen için spinal anestezinin genel anesteziye iyi bir alternatif olabileceğini düşünmekteyiz.

The anesthetic management for cesarean section in a pregnancy with systeic lupus erythematosus(SLE)

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease of unknown cause that predominantly affects females between the ages of 20 and 50 years, but is reported in all age groups. In this case report, we aimed to share our experience of anesthesia which is about a pregnant emergency cesarean section indication breech presentation. Standard monitoring was used and the patient received spinal anesthesia. During the peroperative period, both mother and baby were stable. Newborn’s physical examination and ecochardiography was normal. Mother and baby were discharged from the hospital on the postoperative 3rd day. Therefore, we thought that having a cesarean section under spinal anesthesia for a patient with SLE, whom has taken good preoperative evaluation and postoperative newborn care, might be a good alternative for general anesthesia.

Kaynakça

1. Scott JR. Immunologic diseases in pregnancy. In: Scott JR, DiSaia PJ, Hammond CB, Spellacy WN (eds). Obstetrics and Gynecology. 6 th edition. Philadelphia: J.B. Lippincott; 1990, 551-590.

2. Hayslett JP, Reece EA. Systemic lupus erythematosus in pregnancy. Clin Perinatol 1985; 12: 539.

3. Davies SR. Systemic lupus erythematosus and obstetrical patients implications for the anesthetist. Can J Anaesth 1991; 38: 790-795.

4. Draynini TH, Esterly NB, Fureu N, et al. Neonatal lupus erythematosus. J Am Acad Dermatol 1983; 1: 437.

5. Vetter VL, Rashkind WJ. Congenital complete heart block and connective tissue disease. N Eng J Med 1983; 309: 237.

6. McCarren JP. Systemic Lupus Erythematosus. In: Benumof JL (ed). Anesthesia & Uncommon Diseases. 4th edition. Philadelphia: W.B. Saunders Company; 1998, 61-62.

7. Moga Sampere I, Formiga Perez F, Canet Gonzales R, Pac Ferraz M, Mitjavila Villero F, Fernandez-Nogues F. Pregnancy and systemic lupus erythematosus. Med Clin (Barc) 1993; 101: 530-533.

8. Milhet E, Bouthors-Ducloy AS, Krivosic-Horber R, et al. Obstetrical anesthesia of patients with disseminated lupus erythematosus. Ann Fr Anesth Reanim. 1991; 10: 242-247.

9. Cuenco J, Tzeng G, Wittels B. Anesthetic management of the parturient with systemic lupus erythematosus, pulmonary hypertension, and pulmonary edema. Anesthesiology 1999; 91: 568-570.

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