Bildiri Özetleri

Analgesia and Anaesthesia Management of a Parturient with Paramyotonia Congenita for Labor and Caesarean Delivery

Nazuha Mohd Najid1, Thohiroh Abdul Razak1, Berrin Gunaydin2

1Department of Anaesthesiology at Hospital Kuala Lumpur,Kuala Lumpur, Malaysia
2Department of Anesthesiology at Gazi University School of Medicine, Ankara, Turkey

AIM: Myotonic dystrophies and/or paramyotonia congenita (PC) posse perioperative challenge to the anaesthesiologists1. We aimed to present management of analgesia/anaesthesia in a parturient with PC scheduled to undergo caesarean section (CS). CASE: A 26 year-old pregnant woman was admitted to our unit at 38 weeks’ gestation due to spontaneous rupture of membranes. Diagnosis of PC has been confirmed genetically by SCN4A mutation. She was on carbamazepine therapy. She was suffering from muscle cramps induced by cold weather and eating cold food or exertion which resolve after warming up and resting. After obtaining informed consent, intravenous (IV) patient controlled analgesia (PCA) with 20 µg of fentanyl bolus and 5 minute (min) lock-out time for labor analgesia was proceeded. Soon after augmentation of labour, we sited an epidural catheter. IV fluid warmers, pre-warmed drapes and disinfection solutions were ready to use before performing epidural block. Epidural analgesia was induced with bolus 15 ml of ropivacaine 0.05% including fentanyl 2 µg/ml via epidural PCA and maintained with a 10 ml/h infusion, 10 ml bolus, 10 min lock-out time. Meanwhile, fetal heart rate tracings showed poor beat-to-beat variability requiring discontinuation of oxytocin infusion. Emergency CS was performed after aspiration prophylaxis and standard monitoring including body temperature. Sensory block level at T4 was achieved by top up of 10 mL lidocaine 2% including adrenaline 1:200,000 via functional epidural catheter. Temperature in the operating room was 26.7°C. After delivery, oxytocin infusion was started. Normothermia and stable haemodynamics without any muscle cramps were maintained. The epidural catheter was removed immediately after administering 3 mg epidural morphine. Postoperative multimodal analgesia was provided with diclofenac and paracetamol. CONCLUSION: Management of both analgesia and anaesthesia of a parturient with PC was successfully presented without occurrence of myotonic crisis under meticulous care of hypothermia. Reference: Anaesth Intensive Care 1999

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