Combined general and epidural anesthesia for a patient with Takayasu's arteritis. Case report.

BACKGROUND AND

OBJECTIVES

The case is presented of a 44-year-old woman with type I Takayasu's arteritis, undergoing total abdominal hysterectomy.

METHODS

Her previous symptoms were related to subclavian and vertebral artery lesions that were treated surgically, and to right carotid stenosis (amaurosis fugax 1-year before the operation) that was not treated. Peripheral pulses were present and blood pressure monitoring was not a problem (invasive intra-arterial pressure monitoring was used). Neurologic monitoring was considered to be mandatory in this case and a computerized electroencephalography monitor was used, both to confirm the adequacy of anesthesia and, more importantly, to monitor unilateral cerebrovascular events.

RESULTS

The patient underwent surgery with combined epidural and general anesthesia, without any complications. The epidural block was used throughout the early postoperative period for analgesia.

CONCLUSIONS

The management of patients with Takayasu's arteritis requires a knowledge of the location and pathophysiology of vascular lesions.