Combined Spinal and Epidural Anesthesia for Cesarean Section in a Parturient with Cerebral Arteriovenous Malformation

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A parturient with intracranial arteriovenous malformation presented for elective cesarean section. Combined spinal and epidural anesthesia was employed because it could provide sufficient analgesia and could produce hemodynamic stability. She received subarachnoid block with 7.5 mg of 0.5% isobaric bupivacaine and incremental epidural boluses of 0.75% ropivacaine to a total volume of 6 ml. Intraoperative maternal hemodynamics was stable, and a healthy baby with Apgar scores of 9 and 10 at 1 and 5 min was delivered. Both the mother and baby were discharged six days later uneventfully. Spinal anesthesia with isobaric bupivacaine combined with epidural anesthesia in small incremental local anesthetic may be an applicable anesthetic alternative for cesarean section in patients with intracranial arteriovenous malformation.