1 case of total hemp delivered by caesarean section of a woman with smoke disease was reported.

The patient, female, 28 years old, 75kg, was admitted to hospital for "2 years of smoke disease, 37 plus 6 weeks pregnant and required to be admitted to hospital for child-natal treatment".
2 years ago, patients were diagnosed with smoke disease (Moyamoya disease, MMD) after a sudden headache, vomiting and paralysis of their upper left limb.
after conservative treatment and rehabilitation training so far, only a mild left-handed muscle dystia has increased.
: Blood pressure 121/83mmHg (1mmHg s 0.133kPa), heart rate 108min-1.
examination: blood routine, clotting routine and electrolyte examination is normal;
preoperative diagnosis: smoke disease, G1P0, 37 plus 6 weeks of in-house pregnancy head single live birth to be born.
patients admitted to the operating room after obvious anxiety, refused to perform intravertebral anesthesia.
to monitor patients' electrostectric charts, oxygen saturation, non-invasive blood pressure, and BIS.
mask to oxygen de-nitrogen line full hemp rapid sequence induction, in turn, the veins to give rifentinium 0.075mg plus propofol 120mg plus roku bromine 45mg line trachea intestion, inhalation 2% hexafluorane to maintain anesthesia.
surgery, to be removed by the fetus, the veins add fentanyl 0.15mg plus force of 2mg, reduce the concentration of hexaflurane to 1% to 1.5%, intravenous pump injection of effentinium 0.6 μg/ (kg.min), 20U of urinary urinarytin intravenous drip.
the amount of moisture to maintain the end-of-exhalation CO2 (ETCO2) between 30 and 35mmH, and adjust the depth of anesthesia according to the electroencephaloelectomy index (BIS value).
blood pressure (110 to 125) / (75 to 84) mmHg, heart rate 74 to 89min-1.
signs were stable during the surgery, with a blood loss of about 300mL, and the newborn Apgar scored 9-10-10 points, after which the trachea was removed and transferred to the ICU.
safely discharged on the 4th day after the operation.
Discussion MMD, also known as cerebral abnormal vascular mesh disease, is a very rare cerebrovascular sexual damage disease, mainly manifested in the front and middle arteries of the brain to perform sexual stenosis, accompanied by abnormal formation of the far end of the cranial angiovascular network, because cerebrovascular angioid shape such as smoke and name.
Increased blood volume during pregnancy, high blood clotting and excessive breathing during childbirth can make MMD maternal conditions worse, preventing cerebral hemorrhage or cerebral isoemia is a difficult challenge, there are currently very few reports of pregnancy combined smoke disease.
over-breathing and childbirth pain during vaginal delivery may aggravate the condition of MMD maternal conditions, so MMD maternity is recommended to deliver by caesarean section.
Over-breathing may lead to low-carbon acidemia in the mother, causing MMD lesions blood vessel contraction, local cortical blood flow reduction and cerebral ischemia;
is also dangerous and can cause cerebrovascular dilation, which can lead to cerebral hemorrhage.
MMD maternal, arterial blood carbon dioxide pressure (PaCO2) is recommended to remain between 30 and 35 mmHg.
mmD patients had less cerebral blood flow than normal, the average rate of cerebral blood flow was directly related to the change of average arterial pressure, and the stability of maternal average arterial pressure was very important to maintain proper cerebral blood flow.
the choice of anesthesia is not yet conclusive.
intravertebral anesthesia continuously monitors the patient's nerve function, avoiding stress reactions in whole hemp intives and respiratory suppression in newborns caused by whole hemp drugs.
anesthesia in the vertebral tube can cause patients to have low blood pressure due to intersecting blockages, which can lead to low brain perfusion and brain deficiency.
the whole hemp anaesthetic can reduce the metabolic rate of cerebral oxygen, the brain ischemic protection effect, while the whole hemp intive tube convenient control of breathing, to avoid excessive or insufficient breathing.
stress response to neonatal respiratory suppression and tracheal intive tube pull is the biggest concern for MMD obstetrics.
is the latest opioid-infested astigtor that works quickly, metabolizes quickly, has a strong effect, and the newborn liver also has the ability to metabolize ryfentanie.
In this case, the use of rifentanil for anaesthetic induction, intring stress response is mild, hemodynamic fluctuations are controlled within 20% of the time of entry, nervous system symptoms are not aggravated, the newborn Apgar score is good, indicating that ryventani anesthesia for MMD maternal caesarean section to provide a good anaesthetic effect.
for patient safety reasons, it is recommended that multidisciplinary associations such as anesthesiology, obstetrics, paediatrics and neurology be consulted and that maternal blood pressure and PaCO2 be strictly controlled.
approach to MMD delivery and anesthesia should be tailored to the risk of cerebrovascular events in patients.
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