Takayasu’s arteritis in pregnancy and obstetric anesthesia

Takayasu's arteritis (TA), also called pulseless disease, aortic arch syndrome, occlusive thromboaortopathy, or aortic arteritis, is a chronic vasculitis mainly involving the aorta and/ or, its main branches, such as the brachiocephalic, carotid, subclavian, vertebral, renal, coronary and pulmonary arteries. Major challenges for anesthesia in patients with TA involve severe uncontrolled hypertension, end-organ dysfunction, stenosis of major blood vessels, and difficulties in monitoring arterial blood pressure. The cardiovascular complications attributed to the disease can be seriously enhanced during pregnancy. We present successful anesthetic management of emergency cesarean section under general anesthesia in a parturient with long-standing Takayasu's disease with renovascular hypertension complicated by eclampsia.

Medicine Journal, 2019

Takayasu arteritis or pulseless disease (TD) is a chronic progressive inflammatory disease of the aorta and aortic arch branches. It affects females in reproductive years, accounting for almost 80% of the cases. TD complications may affect pregnancy and labor, thus anesthetic and surgical planning are essential during cesarean delivery. The authors report four cases of patients with TD that have undergone cesarean delivery and discuss their anesthetic management. In all cases anesthesia was carried out with neuraxial anesthesia and hemodynamic parameters were kept stable. Although the anesthetic management of TD is not well defined, it is consensual that one of the main objectives of the management of these patients is the maintenance of maternal and fetal tissue perfusion. It is essential to be cautious about the use of drugs that act on vascular tonus, such as oxytocin and vasoconstrictions drugs, because it can result in reduction of systemic vascular resistance and decrease in cardiac output, increase the risks of angiotensin or vasculitis of the central nervous system. In relation to the other transoperative anesthetic care, these are similar to those required for cesarean sections in non-compliant parturients. A regional anesthetic technique allows the monitoring of cerebral function and can be slowly titrated to prevent hemodynamic instability. It is crucial that the anesthesiologist understands the pathophysiology of TD and the pregnancy-induced physiological changes for the safe management of these patients.

Egyptian Journal of Anaesthesia, 2012

We report the anaesthetic management of a parturient suffering from Takayasu's arteritis scheduled for elective caesarean section. A full term 29-year-old female weighing 50 kg, height 152 cm, gravida3, para 1 with previous lower segment caesarean section (LSCS) was scheduled for elective LSCS. Patient had suffered a right sided frontoparietal infarct 14 years back for which she underwent treatment in the form of medication from some higher centre She was advised tablet aspirin 75 mg and prednisolone 40 mg once a day. Digital subtraction angiography showed complete occlusion of origin of both subclavian and carotids and reformation of collaterals. Echocardiography revealed mild concentric left ventricular hypertrophy, trivial AR and normal left ventricular systolic function. Caesarean section was planned under regional anaesthesia with monitoring gadgets placed on lower limb. Subarachnoid block (SAB) was administered with 7.5 mg hyperbaric bupivacaine along with 25 lg fentanyl at lumbar 4-5 interspace, using a 25-G Quincke Babcock needle. Intra-operative period was uneventful with minimal fall in blood pressure which was managed accordingly. Parturient was stable in the postoperative period and was moved to a ward after being monitored for 24 h in ICU.

Singapore medical journal, 2010

Takayasu's arteritis is a rare form of nonspecific obliterative panarteritis of unknown aetiology. Anaesthesia for patients with Takayasu's arteritis is complicated by severe uncontrolled hypertension leading to end-organ dysfunction, stenosis of major blood vessels affecting regional circulation, and difficulties in the monitoring of arterial blood pressure. The anaesthetic approach for parturients with Takayasu's arteritis has not been standardised in the literature, and previous reports have documented the use of general as well as regional anaesthesia. There are few instances in the literature where low-dose spinal anaesthesia alone is used in patients with Takayasu's arteritis undergoing emergency caesarean section. We present a case of the successful management of a parturient with Takayasu's arteritis, who underwent an emergency caesarean section under low-dose spinal anaesthesia.

International Journal of Health Sciences and Research, 2016

Takayasu’s arteritis (TA) is a rare, inflammatory panarteritis involving aorta and its major branches. Anesthetic implications of TA include uncontrolled hypertension, end organ dysfunction and difficulty in the monitoring of arterial pressure. We are reporting a case of 30 yr. old parturient having TA with schizophrenia and very bad obstetric history, who was managed in high dependency unit from 24 weeks onward under supervision of multidisciplinary team, as lives of both mother and fetus were at stake. She successfully underwent cesarean section in low dose spinal anesthesia using 7.5mg hyperbaric bupivacaine with 25 mcg fentanyl intrathecally. This report highlights that low dose spinal anesthesia remains a good option if mean arterial pressure is maintained to prevent end organ damage. As the patient remains awake, it allows monitoring of cerebral perfusion without the need of sophisticated cerebral function monitor.

The Medical Journal of Okmeydani Training and Research Hospital, 2013

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2012

Takayasu's Arteritis is a rare, chronic idiopathic occlusive inflammation of the aorta and its major branches. We report a 24 year female, primigravida which was a diagnosed case of Takayasu's Arteritis who underwent an emergency caesarean section under spinal anaesthesia. The uneventful course of anaesthesia in the presented case was related to the through systemic evaluation and careful anaesthetic strategy.

1971

The Medieval Chronicle 16, 2023

This article aims to present my current research on the emergence of the nation in late-medieval Europe by comparing urbanized Brabant and feudal Bohemia (1300–1450). Both entities shared, for a while, the same ruling family and belonged to the Holy Roman Empire. Both were characterised by a strong social group competing with the sovereign and by complex linguistic arrangements with social and political implications. Through a new vernacular literature using respectively Czech and Dutch instead of the more established German and French, they both developed a significant sense of the nation, albeit differently due to distinct socio-political balances and experiences. But, while the Czech nation, as a product of the Czech nobility, was associated with feudal and conservative values, that of Brabant was linked to the urban ideals of political representation and liberty. Concentrating on two authors from the beginning of the fourteenth century, Jan of Boendale and the Pseudo-Dalimil, this article shows that the nation had already become a source of legitimacy in the late medieval power struggles between sovereign and political society. THIS IS NOT THE FINAL VERSION OF THE ARTICLE

Follow Most of us are following the innovations & simplifications in S/4 HANA and wondering about the functionalities & business benefits of implementing S/4 HANA (S4H).Find lot of questions on differences in ECC with S/4 HANA (S4H). Trying to highlight the major(not a full list) differences in digital core of S4H as planned by SAP w.r.t ECC Hana database S4H can only be run on Hana database unlike ECC which can be run on Oracle , IBM DB2 etc. Back bone of S4H's design is with HANA's in memory capability and below design principles • In-memory database means that data is read from memory i.e data always reside in main memory RAM (though Write happens in hard disk) and hence in-memory database reads data much faster w.r.t traditional databases (fetching the data from hard disk) • Hana's column based tables provide faster access (as only affected columns need to be read in a query), better compression (due to few distinct values compared to rows), parallel processing (different columns can be easily processed parallely) • OLTP and OLAP capability in same system with real time reporting and predictive analysis • There will be no aggregate (total), index and history tables in S4H. Aggregates are created dynamically based on line item table instantaneously (on the fly). Single source of truth S4H combines the data structures of different components (for FI , AA , CO , CO-PA and ML) into a single line item table ACDOCA, called as Universal journal. It eliminates several aggregate and index tables. Now, data needs to be inserted only a single table instead of several tables thus reducing the data foot print drastically. MATDOC is also a new line item table for inventory management and it eliminates 26+ tables. Material documents will be stored in MATDOC but not in MKPF or MSEG tables. Merger of CO and FI