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Abordagem perioperatória de grávida com angioedema hereditário submetida a cesariana: relato de caso
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Abstract(s)
O angioedema hereditário é uma doenc¸a autossômica dominante, que se manifesta
por crises súbitas, recorrentes e de gravidade variável de edema subcutâneo e submucoso, que
podem ocorrer espontaneamente ou em resposta a gatilhos. São conhecidos três tipos de angioedema hereditário. A doenc¸a é condicionada por diminuic¸ão do nível plasmático ou alterac¸ão
da capacidade funcional do inibidor de C1, com aumento da bradicinina e da permeabilidade
vascular, com consequente edema. Várias medidas devem ser tomadas no período perioperatório de forma a evitar uma crise aguda. A profilaxia deverá ser realizada durante a gravidez
antes de qualquer procedimento cirúrgico, antes de procedimentos dentários, quando existe
manuseamento da via aérea, nos doentes com episódios prévios de angioedema e quando há
alterac¸ões significativas da volemia. A literatura é escassa no que que diz respeito à associac¸ão
de angioedema hereditário e gravidez. Descrevemos um caso de sucesso de uma grávida com
angioedema hereditário tipo I submetida a cesariana.
Hereditary angioedema is an autosomal dominant disorder, presenting as sudden and recurring episodes of variable severity of subcutaneous and mucosa edema that may occur spontaneously or in response to triggers. There are three knwon types of hereditary angioedema. The disorder is caused by decrease in the plasma level or change in the functional capacity of C1 inhibitor, with increase in bradykinin and in vascular permeability, and consequent edema. Several measures are required in the perioperative period in order to avoid an acute attack. Prophylaxis should be carried out throughout pregnancy before any surgical procedure, before dental procedures, upon airway handling, on patients with previous episodes of angioedema, and when there are significant changes in volemia. The literature is scarce in regard to the association between hereditary angioedema and pregnancy. We describe a successful case of a pregnant patient with type I hereditary angioedema submitted to a C-section.
Hereditary angioedema is an autosomal dominant disorder, presenting as sudden and recurring episodes of variable severity of subcutaneous and mucosa edema that may occur spontaneously or in response to triggers. There are three knwon types of hereditary angioedema. The disorder is caused by decrease in the plasma level or change in the functional capacity of C1 inhibitor, with increase in bradykinin and in vascular permeability, and consequent edema. Several measures are required in the perioperative period in order to avoid an acute attack. Prophylaxis should be carried out throughout pregnancy before any surgical procedure, before dental procedures, upon airway handling, on patients with previous episodes of angioedema, and when there are significant changes in volemia. The literature is scarce in regard to the association between hereditary angioedema and pregnancy. We describe a successful case of a pregnant patient with type I hereditary angioedema submitted to a C-section.
Description
Keywords
Gravidez Cesariana Cuidados peri-operatórios Angioedemas hereditários Anestesia
Citation
Rev Bras Anestesiol. 2020 Jan - Feb;70(1):48-50
Publisher
Sociedade Brasileira de Anestesiologia