CLINICAL CASES   Free access

Minerva Anestesiologica 1998 September;64(9):419-23

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: Italian

Caesarian section in patient with a recent ischemic-hemorrhagic cerebral pathology. Spinal anaesthesia

Caputo F.

AUSL BR/1, Ospedale «N. Melli» - San Pietro Vernotico (Brindisi), Servizio Anestesia e Rianimazione

The choice of anaesthesia for Caesarian sections, in patient with recent cerebral ischemic-hemorrhagic injurys, is a big problem. A case is reported of a woman submitted to Caesarian section in spinal anaesthesia who, in the first quarter, suffered an ischemic-hemorrhagic cerebral injury. Spinal anaesthesia was made by hyperbaric bupivacaine 0.5% at 10 mg dose+fentanyl 25 µg using 24G Sprotte needle. Spinal anaesthesia guarantees a good neuroendocrine protection to surgical aggression and a good hemodynamic stability. Hypotension prophylaxis by pre-filled is necessary and its treatment with ephedrine must be timely carried out. Risk of post-dural puncture headache, by atraumatic and very thin needles, is negligible. Spinal anaesthesia avoids general anaesthesia which may cause cardiovascular damages due to oro-tracheal intubation leading to possible cerebral damage. Induction-delivery time is more dangerous: the use of alogenate, oppioids, and/or some medicaments which may control the mother’s adrenergic response, exhibit the newborn to risks.