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Related Experiment Videos

C1-esterase inhibitor deficiency and elective caesarean section.

R J Griffiths1, G O'Sullivan

  • 1Department of Anaesthesia, St Thomas' Hospital, London, UK. richgriffiths@doctors.org.uk

International Journal of Obstetric Anesthesia
|June 7, 2005
PubMed
Summary

C1-esterase inhibitor deficiency management in pregnancy requires careful planning. Regional anesthesia for cesarean delivery proved safe and effective for this patient with hereditary angioedema.

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Area of Science:

  • Immunology
  • Anesthesiology

Background:

  • C1-esterase inhibitor deficiency (hereditary angioedema) is a rare complement system disorder causing recurrent edema.
  • Airway edema, a life-threatening complication, can be triggered by airway instrumentation or trauma.

Observation:

  • A 37-year-old primiparous woman with known C1-esterase inhibitor deficiency underwent elective cesarean section at 38 weeks' gestation.
  • Previous general anesthesia resulted in facial and pharyngeal edema despite prophylaxis.

Findings:

  • The patient received intrathecal anesthesia with bupivacaine and diamorphine for the cesarean section.
  • Cardiovascular stability was maintained with glycopyrrolate and intravenous fluids.
  • A successful live birth occurred with no peri- or postoperative complications.

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Implications:

  • Regional anesthesia is the safest anesthetic method for obstetric surgery in patients with C1-esterase inhibitor deficiency.
  • Elective cesarean section under regional anesthesia should be considered for predicted difficult vaginal deliveries in these patients.