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Journal of Obstrectic Anaesthesia and Critical Care
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LETTER TO EDITOR
Year : 2021  |  Volume : 11  |  Issue : 1  |  Page : 48

Anesthesia options for caesarean delivery of a paraplegic parturient with transverse myelitis: Past and present


Department of Anesthesiology, Gazi University School of Medicine, Ankara, Turkey

Date of Submission03-May-2020
Date of Acceptance05-Jan-2021
Date of Web Publication16-Apr-2021

Correspondence Address:
Prof. Berrin Gunaydin
Department of Anesthesiology, Gazi University School of Medicine, Besevler, Ankara - 06500
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacc.JOACC_38_20

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How to cite this article:
Gunaydin B, Akcali DT, Alkan M, Inan G. Anesthesia options for caesarean delivery of a paraplegic parturient with transverse myelitis: Past and present. J Obstet Anaesth Crit Care 2021;11:48

How to cite this URL:
Gunaydin B, Akcali DT, Alkan M, Inan G. Anesthesia options for caesarean delivery of a paraplegic parturient with transverse myelitis: Past and present. J Obstet Anaesth Crit Care [serial online] 2021 [cited 2021 Jun 15];11:48. Available from: https://www.joacc.com/text.asp?2021/11/1/48/313909



Sir,

We have read with interest the unique anesthetic approach for a 24-year-old term primigravida with idiopathic transverse myelitis who underwent emergency Caesarean section (CS) under monitored anesthesia care (MAC) using minimal analgesic support.[1] Authors clearly highlighted potential concerns associated with neuromuscular agents used for general anesthesia like hyperkalemia due to succinylcholine or delayed reversal from nondepolarizing muscle relaxants but neuraxial anesthesia option has not been even mentioned because of level of sensory deficit. However, anesthetic management of a 29-year-old paraplegic woman suffering from Devic's Syndrome scheduled for emergency CS due to fetal distress under epidural anesthesia presented in 2001 was overlooked.[2] Despite challenges to choice of anesthesia technique and controversies in neuraxial anesthesia, after obtaining informed consent of the patient we performed epidural anesthesia to avoid high risk of autonomic hyperreflexia, a complication arising from transverse myelitis, one of the components of the Devic's syndrome (neuromyelitis optica).[2],[3],[4],[5] Our case had hypoesthesia below the T2 dermatome with urinary and fecal incontinence. Her neurological exam revealed progressive paraparesis and paraplegia associated with pathological reflexes (Babinski and clonus), and a hyperintense lesion between C5 and T4 in MRI of the vertebral column confirmed by contrast uptake. Administration of 8 mL 0.5% bupivacaine +50 μg fentanyl via epidural catheter provided satisfactory anesthesia with a sensory block level at T4 followed by 0.125% of 10 mL bupivacaine for postoperative analgesia uneventfully.

Even though MAC was presented to be a unique approach for Cesarean delivery of a paraplegic parturient resulting from transverse myelitis, I wish Saxena et al.[1] could have discussed neuraxial anesthesia with a particular reference to our case report where we successfully optimized our epidural anesthesia/analgesia management in a similar paraplegic parturient with this rare condition.[2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Saxena KN, Kaul A, Shakir M. Anesthetic management of an obstetric patient with idiopathic transverse myelitis: A unique approach! J Obstet Anaesth Crit Care 2019;9:99-101.  Back to cited text no. 1
    
2.
Gunaydin B, Akcali D, Alkan M. Epidural anaesthesia for Caesarean section in a patient with Devic's syndrome. Anaesthesia 2001;56:565-7.  Back to cited text no. 2
    
3.
Sibley WA. Demyelinating diseases Devic syndrome and Balo disease. In: Rowland LP, editor. Merit's Textbook of Neurology. USA: Lea and Febiger; 1989. p. 760-1.  Back to cited text no. 3
    
4.
Berghella V, Spector T, Trauffer P, Johnson A. Pregnancy in patients with preexisting transverse myelitis. Obstet Gynecol 1996;87:809-12.  Back to cited text no. 4
    
5.
Marabani M, Zoma A, Hadley D, Sturrock R. Transverse myelitis occurring during pregnancy in a patient with systemic lupus erythematosus. Ann Rheumatic Dis 1989;48:160-2.  Back to cited text no. 5
    




 

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