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[Perioperative management of a patient with Sneddon syndrome--a case report].
[sneddon syndrome]
Sneddon
's
syndrome
is
a
rare
combination
of
generalised
livedo
reticularis
and
cerebrovascular
accidents
.
Its
clinical
presentation
varies
widely
and
its
aetiology
is
still
not
known
.
60
to
80
%
of
patients
are
female
.
First
symptoms
of
the
syndrome
are
mostly
repetitive
cerebral
strokes
,
but
reduced
perfusion
of
the
skin
,
seen
as
blue
or
red
-
brown
mottling
,
precedes
the
strokes
.
The
vascular
disease
is
generalised
and
often
accompanied
by
arteriosclerosis
,
systemic
arterial
hypertension
,
valvular
heart
disease
and
the
presence
of
antiphospholipid
antibodies
.
The
diagnostic
procedures
are
complicated
and
have
to
exclude
other
autoimmunological
diseases
.
Therapeutic
options
are
anticoagulatory
therapy
with
warfarin
,
ASS
or
heparin
,
reduction
of
endothelial
proliferation
with
ACE
-inhibitors
,
and
improvement
of
microvascular
perfusion
with
prostaglandine
.
The
increased
anaesthesiological
risk
with
these
patients
is
due
to
the
acute
risk
of
thromboembolism
and
ischaemic
cerebral
and
cardiovascular
insults
.
The
anaesthetic
management
must
provide
stable
perfusion
pressures
for
cerebral
and
myocardial
arteries
and
avoid
increasing
risk
factors
for
thromboembolism
such
as
increased
blood
viscosity
or
stasis
due
to
improper
positioning
of
the
patient
.
The
choice
of
anaesthetic
drugs
is
dependent
on
good
controllability
for
haemodynamic
stability
.
The
high
risk
of
patients
with
Sneddon
's
syndrome
justifies
a
more
invasive
haemodynamic
monitoring
and
postoperative
surveillance
on
an
intensive
care
unit
.
This
case
report
describes
the
anaesthesiological
considerations
for
,
and
management
of
,
a
patient
with
Sneddon
's
syndrome
who
was
admitted
to
hospital
for
vaginal
hysterectomy
.
Diseases
Validation
Diseases presenting
"the acute risk of thromboembolism"
symptom
sneddon syndrome
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