[Horner syndrome and brachial plexus blockade after epidural anesthesia for obstetric labor and cesarean section]. / Síndrome de Horner y bloqueo del plexo braquial tras anestesia epidural para trabajo de parto y cesárea.

A 30-year-old woman (ASA II, obese) in her 40th week of a first pregnancy required epidural analgesia for labor. When the cervix had dilated to 5 cm, the epidural infusion was started with a 9-mL bolus of 0.2% ropivacaine and 50 pg of fentanyl, after a negative test dose. An infusion of 0.2% ropivacaine and 1 microg/mL of fentanyl was started at a rate of 8 mL/h. A cesarean section was required after insufficient progress was made during 8 hours of labor. Eight milliliters of 0.75% ropivacaine was administered to provide anesthesia to T4; cesarean delivery was completed without complications. Early during postoperative recovery, in addition to motor blockade of the legs, the patient experienced a right brachial plexus blockade and Horner syndrome on the same side. Both effects disappeared spontaneously (1 and 4 hours later, respectively).

Síndrome de Horner y bloqueo del plexo braquial tras anestesia epidural para trabajo de parto y cesárea / Horner syndrome and brachial plexus blockade after epidural anesthesia for obstetric labor and cesarean section

Presentamos el caso de una paciente gestante de 30 años, ASA II, obesa, prímipara en la semana en la semana 40 de gestación, que requirió analgesia epidural para el trabajo de parto. Se instauró la analgesia epidural a los 5 cm de dilatación cervical con un bolus de 9 ml de ropivacaína 0,2% y 50 mg de fentanilo previa dosis test negativa. Posteriormente se inició una perfusión de ropivacaína 0,2% y fentanilo 1 mg/ml a 8 ml/h. Tras 8 horas de evolución hubo que realizar cesárea por distocia de progresión. En el quirófano se administraron 8 ml de ropivacaína 0,75% y se alcanzó un nivel anestésico T4. Se realizó la cesárea sin complicaciones. En el postoperatorio inmediato la paciente presentó además del bloqueo motor de extremidades inferiores un bloqueo del plexo braquial derecho y un síndrome de Horner ipsilateral. Tanto el bloqueo del plexo como el síndrome de Horner desaparecieron espontáneamente 1 y 4 horas después respectivamente(AU)

A 30-year-old woman (ASA II, obese) in her 40th week of a first pregnancy required epidural analgesia for labor. When the cervix had dilated to 5 cm, the epidural infusion was started with a 9-mL bolus of 0.2% ropivacaine and 50 mg of fentanyl, after a negative test dose. An infusion of 0.2% ropivacaine and 1 mg/mL of fentanyl was started at a rate of 8 mL/h. A cesarean section was required after insufficient progress was made during 8 hours of labor. Eight milliliters of 0.75% ropivacaine was administered to provide anesthesia to T4; cesarean delivery was completed without complications. Early during postoperative recovery, in addition to motor blockade of the legs, the patient experienced a right brachial plexus blockade and Horner syndrome on the same side. Both effects disappeared spontaneously (1 and 4 hours later, respectively)(AU)

[Anesthetic management in a pregnant woman suffering from idiopathic thrombocytopenic purpura]. / Manejo anestésico en gestante afecta de púrpura trombocitopénica idiopática.

Idiopathic thrombocytopenic purpura is an autoimmune disorder characterized by a low platelet count. Onset usually occurs during adolescence with episodes of cutaneous and mucosal bleeding. Thrombocytopenia during pregnancy is associated with many diseases, of which idiopathic thrombocytopenic purpura is the most common in the first trimester. The need for treatment will depend on the platelet count and whether there is bleeding. At the end of pregnancy, however, whether delivery is vaginal or by cesarean, more aggressive therapeutic measures are required. Anesthetic management in this type of patient will be determined by coagulation status and platelet count, and local or regional anesthesia may be contraindicated. We report the case of a pregnant woman with idiopathic thrombocytopenic purpura who was admitted to the emergency department of our hospital with suspected preeclampsia.

Manejo anestético en gestante afecta de púrpura trombocitopénica idiopática / Anesthetic management in a pregnant woman suffering from idiopathic thrombocytopenic purpura

La púrpura trombocitopénica idiopática (PTI) es untrastorno autoinmune, caracterizado por plaquetopenia,que suele debutar durante la adolescencia y que cursa enforma de brotes con episodios de sangrado cutáneomucoso.Existen muchas patologías asociadas a trombocitopeniadurante la gestación, siendo la PTI la más frecuentedurante el primer trimestre del embarazo. Lanecesidad de tratamiento dependerá del recuento de plaquetasy de la presencia de clínica hemorrágica. Sinembargo, cuando finaliza la gestación (tanto vía vaginalcomo cesárea) hay que tomar medidas terapéuticas másagresivas. El manejo anestésico de este tipo de pacientesvendrá determinado por el estado de la coagulación y elrecuento plaquetar, puediendo estar contraindicada unaanestesia locorregional. Presentamos el caso de una gestanteafecta de PTI que acudió al servicio de urgenciasde nuestro centro por sospecha de preeclampsia(AU)

Idiopathic thrombocytopenic purpura is anautoimmune disorder characterized by a low plateletcount. Onset usually occurs during adolescence withepisodes of cutaneous and mucosal bleeding.Thrombocytopenia during pregnancy is associated withmany diseases, of which idiopathic thrombocytopenicpurpura is the most common in the first trimester. Theneed for treatment will depend on the platelet count andwhether there is bleeding. At the end of pregnancy,however, whether delivery is vaginal or by cesarean, moreaggressive therapeutic measures are required. Anestheticmanagement in this type of patient will be determined bycoagulation status and platelet count, and local or regionalanesthesia may be contraindicated. We report the case ofa pregnant woman with idiopathic thrombocytopenicpurpura who was admitted to the emergency departmentof our hospital with suspected preeclampsia(AU)