Assuntos
Raquianestesia/efeitos adversos , Trombose Intracraniana/induzido quimicamente , Inibidores da Fosfodiesterase 5/efeitos adversos , Citrato de Sildenafila/efeitos adversos , Trombose Venosa/induzido quimicamente , Adulto , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Angiografia Digital/métodos , Angiografia Cerebral/métodos , Veias Cerebrais/diagnóstico por imagem , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Disfunção Erétil/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Masculino , Cefaleia Pós-Punção Dural/diagnóstico por imagem , Cefaleia Pós-Punção Dural/etiologia , Cefaleia Pós-Punção Dural/terapia , Tomografia Computadorizada por Raios X , Agentes Urológicos/efeitos adversos , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapiaRESUMO
BACKGROUND: Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. The potential for difficult airway management with the patient under general anesthesia is one of the major concerns that needs to be addressed to prevent further cord compression. Anesthetic management should also include measures to maintain the mean arterial pressure to improve spinal cord perfusion. Furthermore, spine surgery in pregnant patients needs special consideration in terms of positioning and in the postoperative period. CASE PRESENTATION: We present a case of a 35-year-old white woman at 21 weeks of gestation with a spontaneous cervical epidural hematoma. Fiberoptic bronchoscope-guided nasal intubation was a safe option to ensure a higher rate of successful endotracheal intubation while minimizing the risk of aggravating the injury. Her care posed other multiples challenges that required a multidisciplinary team approach. CONCLUSIONS: The case of our patient serves as a reminder of this rare condition and its implications regarding anesthesia.