[Anesthesia for cesarean hysterectomy in a parturient with placenta accreta]

A 35-year-old parturient highly suspicious of the placenta accreta/increta was scheduled for cesarean hysterectomy. She had received two cesarean sections and two intrauterine curettages. Prior to cesarean hysterectomy, 900 g of autologous blood was stored for the predictable massive bleeding. Epidural catheter was introduced at T12-L1 the day before surgery. Bilateral internal iliac artery occlusion balloons were placed in the angiography suite under local anesthesia. Bilateral double J ureteral catheters were inserted under epidural anesthesia in the operating room. Then, the general anesthesia was induced followed by immediate delivery of the baby uneventfully by cesarean section. The occlusion balloons of bilateral internal iliac arteries were inflated immediately after the umbilical cord was clamped so as to minimize the risk of fetal ischemia. Hysterectomy was performed uneventfully. Intraoperative blood loss was 1,170 g, and 300 g of autologous blood was transfused. The postoperative course was uneventful and the patient was discharged 14 days after operation. Histopathological diagnosis was placenta accreta. We successfully managed the anesthesia for cesarean hysterectomy in a parturient with placenta accreta under a combination of general anesthesia and epidural anesthesia.