Ferrer-Zaccaro LE, Triana C, Pérez-Zauner AM

Language: Spanish
References: 10
Page: 126-130
PDF size: 533.86 Kb.

ABSTRACT

A 24 year-old female patient with a 38-weeks of pregnancy and quadriplejia as sequel of transverse myelitis at 10 months of age. She is schedule for an elective cesarean section due to cephalopelvic disproportion. The pregnancy was uneventful and there were not significant clinical progression of the neurological disease. The case is discussed in a multidisciplinary team and single–shot spinal anesthesia with bupivacaine and fentanyl is decided. Postoperative treatment in the intermediate care unit was provided for analgesic control and respiratory therapy. Analgesia was achieved by intravenous hydromorphone and follow–up by pain clinic physicians for management of autonomic hyperreflexia episodes. We discuss the anesthetic considerations in planning the perioperative care of a patient with an infrequent neurological disease in the obstetric population.

REFERENCES

1. Kalsbeek WD, McLaurin RL, Harris BSH, Miller JD. National head and spinal cord injury survey: major findings. Neurosurg 1980;53:S19-31.

2. Skowronsk E. And Hartman K. Obstetric management following traumatic tetraplegia: Case series and literature review. Australian and New Zealand Journal of Obstetrics and Gynaecology 2008;48:485–491. DOI: 10.1111/j.1479-828X

3. Walsh P, Grange C, Beale N. Anaesthetic management of an obstetric patient with idiopathic acute transverse myelitis. International Journal of Obstetric Anesthesia 2010;19:98–101.

4. Jadhav D, Brooks H. Anaesthetic management of labour in a woman with quadriplegia and autonomic hyperreflexia. International Journal of Obstetric Anesthesia 2004;13:294–295.

5. Kuczkowski KM. Labor analgesia for the parturient with an uncommon disorder: a common dilemma in the delivery suite. Obstetric Gynecology Survey 2003;58:800–803.

6. Brinar VV, Habek M, Zadro I, Barun B, Ozretic D, Vranjes D. Current concepts in the diagnosis of transverse myelopathies. Clinical Neurology and Neurosurgery 2008;110:919–927.

7. Ahmed BM, Registrar DG, Bogod MB. Anesthetic management of a quadriplegic patient with severe respiratory insufficiency undergoing caesarean section. Anaesthesia 1996;51:1043–1045.

8. Burns R, Clark VA. Epidural anaesthesia for caesarean section in a patient with quadriplegia and autonomic hyperreflexia. International Journal of Obstetric Anesthesia 2004;13:120–123.

9. Kuczkowski KM. Labor analgesia for the parturient with neurological disease: what does an obstetrician need to know? Archives of Gynecology and Obstetrics 2006;274:41–46.

10. Neal JM, Bernards CM, Hadzic A, Hebl JR, Hogan QH, Horlocker TT, Lee LA, Rathmell JP, Sorenson EJ, Suresh S, Wedel DJ. ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine. Regional Anesthesia and Pain Medicine 2008;33:404-15.