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 Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 6  |  Issue : 2  |  Page : 107-108

Anesthetic management of parturients with cerebral palsy and polymyositis coming for cesarean section: Two case reports


Department of Anaesthesia, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India

Date of Web Publication7-Oct-2016

Correspondence Address:
Dr. K R Halemani
A3 “SAYANA”; “SUHA” Residency, Poonthi Road, Kumarapuram, Trivandrum - 695 011, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4472.191600

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How to cite this article:
Halemani K R, Basheer S, Ahmmed N. Anesthetic management of parturients with cerebral palsy and polymyositis coming for cesarean section: Two case reports. J Obstet Anaesth Crit Care 2016;6:107-8

How to cite this URL:
Halemani K R, Basheer S, Ahmmed N. Anesthetic management of parturients with cerebral palsy and polymyositis coming for cesarean section: Two case reports. J Obstet Anaesth Crit Care [serial online] 2016 [cited 2019 Dec 7];6:107-8. Available from: http://www.joacc.com/text.asp?2016/6/2/107/191600

Sir,

The availability of advanced treatment for infertility and good antenatal care makes patients with various rare medical diseases presenting with pregnancy opt for cesarian section. Anesthetic management of such parturients becomes challenging, especially during emergency situations.

We hereby report two cases, which are not routinely encountered and the knowledge about the management of such cases is through previous case reports.

First case

A 23-year-old parturient with cerebral palsy (CP) presented for elective lower segment cesarian section (LSCS). She had developed CP due to birth asphyxia and had dysarthria, altered gait, and mild lower lumbar scoliosis. There was no athetoid movement.

She was successfully managed with spinal anesthesia (SA) using 0.5% bupivacaine heavy. Even though she was cooperative, epidural was not considered because she could not sit in a steady position for a long duration. Postoperatively, bilateral ultrasound-guided transverse abdominal plain block was given with 0.25% levobupivacaine with 150 µg of buprenorphine.

Second case

A 38-year-old primigravida with polymyositis was posted for LSCS. Her hip extensors were severely affected, leading to difficulty in rising from a seated position and she could not walk without support. She was on ayurveda treatment. Her cardiac and respiratory functions were normal.

She was successfully managed with graded lumbar epidural anesthesia using 0.5% levobupivacaine. (sensory block level achieved: T6) There was no postoperative deterioration of muscle function. Postoperatively, epidural analgesia was continued for 12 h. Prophylaxis against deep vein thrombosis was started 4 h after removal of the epidural catheter.


  Discussion Top


CP is the result of injury to the developing brain during antenatal, perinatal, or postnatal period.[1] Patients with CP can have spinal deformities, and postural and movement defects.[2] Regional anesthesia in such patients can trigger harmful athetotic crisis or increased risk of failure due to spinal deformities.[3]

Polymyositis is an idiopathic inflammatory myopathy and very rare to present with pregnancy.[4] It has symmetric proximal muscle weakness, and can be associated with cancers, systemic lupus erythematosis, scleroderma, rheumatoid arthritis, or dermatomyositis.[4] The disease resembles muscular dystrophies, drug toxicities, and metabolic or hormonal disorders.[5] It can present for the first time during pregnancy and chronic disease might get flared up during pregnancy, affecting the fetus' well-being.[5] General anaesthesia (GA) carries the risk of delayed recovery from muscle relaxants, aspiration pneumonia, malignant hyperthermia, and development of arrhythmias.[4] SA carries risk of high level of blockade, hypotension, and hampering of respiratory muscles.[5]


  Conclusion Top


  1. If there is not so severe spinal deformity or athetoid movements, parturients with CP can be managed under regional anaesthesia.
  2. The risks associated with GA outweigh the rare possibility of nerve damage associated with epidural anaesthesia in parturients with polymyositis.


Acknowledgement

We sincerely thank the Department of Anaesthesiology, Kerala Institute of Medical Sciences (KIMS) for the support and technical help.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nolan J, Chalkiadis GA, Low J, Olesch CA, Brown TC. Anaesthesia and pain management in cerebral palsy. Anaesthesia 2000;55:32-41.  Back to cited text no. 1
[PUBMED]    
2.
Inal M. Anaesthetic management of a patient with cerebral palsy during cesarian section. Int J Anesthesiol 2006;15.  Back to cited text no. 2
    
3.
Žalac D, Kovačević M, Habek D. Delivery and anaesthesia in a parturient with severe cerebral palsy. Gynecol Perinatol 2012;21:154-5.  Back to cited text no. 3
    
4.
Gunusen I, Karaman S, Nemli S, Firat V. Anaesthetic management for cesarean delivery in a pregnant woman with polymyositis: A case report and review of literature. Cases J 2009;2:9107.  Back to cited text no. 4
[PUBMED]    
5.
Shikha S, Lakshmi J, Nitin S, Jayashree S. Anaesthetic management for laparoscopic cholecystectomy in two patients with biopsy proven polymyositis. Indian J Anaesth 2007;51:43-6.  Back to cited text no. 5
    




 

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