Kombinovana spinalna-epiduralna anestezija za carski rez kod porodilje sa spinalnom mišićnom atrofijom tip II
Sažetak
Uvod. U ovom slučaju prikazano je vođenje anestezije kod porodilje sa spinalnom mišićnom atrofijom tip II, kod koje je urađen elektivan carski rez u neuroaksijalnoj anesteziji. Prikaz slučaja. Žena, stara 33 godine, kojoj je ovo bila prva trudnoća, u 39-oj nedelji gestacije bila je planirana za carski rez zbog placente previje. U anamnezi je imala spinalnu mišićnu atrofiju tip II, korektivnu operaciju kifoskolioze, i bila je vezana za invalidska kolica. Odluka da se radi u kombinovanoj spinalno-epiduralnoj anesteziji donešena je zbog prisustva prediktora za otežanu intubaciju (ograničeno otvaranje usta, ograničena pokretljivost vratne kičme). Haringtonove šipke i ožiljno tkivo komplikovali su primenu kombinovane spinalno-epiduralne anestezije, ali je anestezija ipak uspešno primenjena. Zaključak. Spinalna mišićna atrofija u trudnoći veoma je retka i predstavlja veliki izazov za anesteziologa zbog respiratorne disfunkcije, očekivane otežane intubacije, teške kifoskolioze i ograničenja u primeni neuromišićnih relaksanata. U radu su prikazani potencijalni rizici koje treba uzeti u obzir prilikom primene anestezije za carski rez kod porodilja sa spinalnom mišićnom atrofijom.
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