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• W1738593611 abstract "We present the first report of anaesthesia and surgery in an adult with Sneddon's syndrome. We describe the cerebral involvement, arterial hypertension, cardiac disease, prothrombotic condition and compromised renal function, which affect the peri-operative care of patients with this syndrome. A 23 year-old woman with Sneddon's syndrome with livedo reticularis, acrocyanosis and coagulopathy (activated protein C resistence and factor V Leiden mutation), presented with spondylolisthesis. She underwent L5-S1 intertransverse fusion with pedicle fixation under general anaesthesia. Pre-operative examination revealed hypertension (150/95 mmHg). She was given nadroparin 2500 iu subcutaneously (a low molecular weight heparin) 4 h before surgery, and was premedicated with midazolam and intramuscular atropine. Elasticated stockings were applied. Anaesthesia was induced with propofol, remifentanil and succinylcholine, and mantained with sevoflurane in oxygen and air and a remifentanil infusion. Boluses of cisatracurium were used to maintain neuromuscular paralysis and an esmolol infusion started. She remained stable throughout the procedure. Dipyrone (metamizol), a non-steroidal anti-inflammatory drug, and pethidine were given before the end of surgery, which lasted 150 min. Postoperatively she was transferred to the Neurointensive Care Unit, where neurological examination was normal. The hypertension was controlled with enalapril; nadroparin was continued until ambulation. Subsequent recovery was uneventful. Sneddon's syndrome is a rare disease characterised by livedo reticularis, acrocyanosis and multiple cerebrovascular events, associated with systemic hypertension, valvular heart disease, convulsions, Raynaud's phenomenon and renal impairment [1]. Many patients have antiphospholipid antibodies or the lupus anticoagulant as well as activated protein C (APC) resistence [2] which may result in venous thrombosis [3]. Careful neurological examination to determine the extent of disability from previous stroke is important. Systemic arterial hypertension is frequently found in these patients [4] and should be controlled in the peri-operative period. We chose the ultra short-acting agent esmolol. Reduced creatinine clearance and moderate elevation of plasma creatinine has been reported [5, 6], and urine production should be monitored. Avoidance of dehydration and attempts to mantain normothermia are important to prevent thromboses." @default.
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• W1738593611 date "2004-05-12" @default.
• W1738593611 modified "2023-10-14" @default.
• W1738593611 title "Sneddon's syndrome and anaesthesia" @default.
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• W1738593611 doi "https://doi.org/10.1111/j.1365-2044.2004.03819.x" @default.
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