Griffiths R J, O'Sullivan G
Department of Anaesthesia, St Thomas' Hospital, London, UK.
Int J Obstet Anesth. 2005 Jul;14(3):263-4. doi: 10.1016/j.ijoa.2004.12.006.
C1-esterase inhibitor deficiency is a rare disorder of the complement system characterised by episodes of cutaneous and mucosal oedema. Life-threatening airway oedema can follow airway instrumentation or minor trauma. We describe the successful management of a 37-year-old primiparous woman with inherited C1-esterase inhibitor deficiency who was admitted at 38 weeks' gestation for elective caesarean section. Whilst undergoing general anaesthesia 18 months previously she had experienced facial and pharyngeal oedema despite prophylaxis (one unit of fresh frozen plasma). On this occasion she underwent elective caesarean section following intrathecal anaesthesia with 0.5% hyperbaric bupivacaine 2 mL and diamorphine 300 microg. Cardiovascular stability was ensured using glycopyrolate and intravenous Hartmann's solution 2 L; a live female infant was delivered successfully. There were no peri- or postoperative complications. Regional anaesthesia is the safest method for providing surgical anaesthesia in the obstetric patient. We believe elective caesarean section under regional anaesthesia should be considered if there are predicted difficulties with vaginal delivery.
C1酯酶抑制剂缺乏症是一种罕见的补体系统疾病，其特征为皮肤和黏膜水肿发作。气道器械操作或轻微创伤后可能会出现危及生命的气道水肿。我们描述了一名37岁初产妇的成功治疗过程，该产妇患有遗传性C1酯酶抑制剂缺乏症，在妊娠38周时因择期剖宫产入院。18个月前她在接受全身麻醉时，尽管采取了预防措施（输注1单位新鲜冰冻血浆），仍出现了面部和咽部水肿。此次，她在鞘内注射2 mL 0.5%重比重布比卡因和300微克二氢吗啡后接受了择期剖宫产。使用格隆溴铵和2升静脉注射复方氯化钠溶液确保了心血管稳定性；成功分娩出一名活女婴。围手术期和术后均无并发症。区域麻醉是为产科患者提供手术麻醉的最安全方法。我们认为，如果预计阴道分娩有困难，应考虑在区域麻醉下进行择期剖宫产。
