|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 48
Anesthesia options for caesarean delivery of a paraplegic parturient with transverse myelitis: Past and present
Berrin Gunaydin, Didem T Akcali, Metin Alkan, Gozde Inan
Department of Anesthesiology, Gazi University School of Medicine, Ankara, Turkey
|Date of Submission||03-May-2020|
|Date of Acceptance||05-Jan-2021|
|Date of Web Publication||16-Apr-2021|
Prof. Berrin Gunaydin
Department of Anesthesiology, Gazi University School of Medicine, Besevler, Ankara - 06500
Source of Support: None, Conflict of Interest: None
|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 14];11:48. Available from: https://www.joacc.com/text.asp?2021/11/1/48/313909
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. 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. 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).,,, 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. 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.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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