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Successful use of epidural anesthesia for cesarean section in a parturient with large arteriovenous malformation (AVM) involving the cervical-medullary junction
Abstract Number: T3D-8
Abstract Type: Case Report/Case Series
Successful use of Epidural anesthesia for cesarean section in a parturient with large arteriovenous malformation (AVM) involving the cervical-medullary junction.
Arteriovenous malformation (AVM) is a congenital focal anomaly of the blood vessels resulting in abnormal arteriovenous shunting. Its prevalence is about 0.01% of the general population and the risk of hemorrhage is approximately 3%. History of previous hemorrhage poses increased risk of subsequent hemorrhage. The bleeding risk is multifold during delivery and in the post- partum period. We present a case of a parturient with large AVM involving the entire cervical-medullary junction who had cesarean section under epidural anesthesia.
20 year-old G1P0 female at 38 weeks of gestation admitted for cesarean section in active labor. Prenatal complications included hemorrhage due to a cervico-medullary AVM three years ago (Fig 1). Provocative test showed complete loss of motor function with high risk of hemiplegia if embolization carried out. She was admitted in ICU and had medical management. Symptoms resolved in few days. During prenatal care, Neurosurgery advised cesarean section due to the risk of rebleeding. After reviewing the risks and benefits of multiple anesthesia techniques, a lumbar epidural was preferred and placed uneventfully. Adequate neuraxial block for cesarean section was achieved with incremental dosing of 2% lidocaine. The patient remained hemodynamically stable throughout the surgery. The cesarian section was unremarkable as well as the postoperative period. The patient was discharged home on post-op day 4 without complications.
Hemodynamic stability in parturients with AVM is crucial. The risk of hypotension after spinal anesthesia commonly leads to overtreating with sympathomimetics leading to hypertension which can be detrimental in this population. Furthermore, general anesthesia should be avoided if possible as intubation and incisional pain can cause hypertension via direct sympathetic stimulation. Continuous epidural anesthesia avoids these complications by giving sympathectomy and analgesia in a more controlled manner and is safest for patients with AVM.