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A 47-year-old woman with a history of a pulsatile headache, photophobia, dizziness and blurred vision was diagnosed with a massive expansive meningioma and proposed for surgical excision. During surgery, the patient began to show progressive haemodynamic instability with extreme hypotension and severe arrhythmia that only responded to epinephrine. With the continuity of haemodynamic instability, ST segment elevation and great amount of blood loss, the surgery was postponed. The follow-up brain CT scan showed evidence of posterior reversible encephalopathy syndrome and cardiac catheterisation diagnosed as Takotsubo syndrome. The patient remained sedated under aminergic support and was admitted to a cardiac intensive care unit. After clinic stabilisation, the patient underwent two more surgical procedures with special attention paid to monitoring haemodynamic stability, blood loss and cardiac output. After 70 days of admission, the patient was discharged with moderate visual impairment and follow-up consultations in neurosurgery and cardiology.

Introduction: Langerhans cell histiocytosis (LCH) is a rare heterogeneous disease that normally occurs in children under 15 years but can rarely be diagnosed in adulthood. It can affect any organ of the body, and a less favorable prognosis is expected when either liver, lung, spleen, or bone marrow are affected. Diabetes insipidus, from pituitary dysfunction, is one of the most common consequences that can develop anytime during the disease, and symptoms normally worsen during pregnancy. Pregnancy with this disease is uncommon, and when it occurs, a cesarean section is normally performed. Case Presentation: We report a 34-year-old pregnant woman (37 weeks and two days gestation) with the diagnosis of a disseminated LCH at the age of 30 who presented herself at the obstetrics emergency department due to respiratory distress. During pregnancy, her pulmonary function remained stable, and she was asymptomatic until the last two days before she was admitted. Labor was induced, with vaginal misoprostol, to achieve a vaginal birth with epidural analgesia. The child was born without complications, and the patient had an immediate clinical improvement. In the following three months, she remained asymptomatic without any worsening of her disease. Conclusions: In LCH, a cesarean section is the first choice in many cases due to pulmonary impairment. We concluded that early placement of an epidural catheter allows labor analgesia while safeguarding the possibility of an epidural anesthesia in case of urgent/emergent cesarean section. If pulmonary function remains stable, vaginal delivery is possible, thereby being less invasive and allowing for a faster recovery.

Cardiac arrest is relatively an uncommon event during cesarean sections. That’s why obstetric teams have low exposure to these critical situations and need frequent training in early identification, differential diagnosis and treatment. We present a case report of a 36-year-old woman, who underwent cesarean section under spinal anesthesia due to delayed labor progress. Once the skin incision was performed the patient underwent asystole. There is a wide range of etiologies for maternal cardiac arrest. We describe and analyze the possible etiologies that could have led to cardiac arrest in this particular case. Citation: Germanova L, Czajkowska K, Gomes J, Infante C, Castro M, Martins I. Cardiac arrest during cesarean section - A case report. Anaesth pain & intensive care 2019;23(4)__ Received: 10 September 2019, Reviewed: 28 September, 23 October 2019, Revised: 24 October 2019, Accepted: 28 October 2019