L A Weston1, C A DiFazio. 1. Department of Anesthesiology, University of Mississippi Medical Center, Jackson 39216-4505, USA.
Abstract
BACKGROUND AND OBJECTIVES: A case of labor analgesia and anesthesia in a 23-year-old woman with spinal muscular atrophy and vocal cord paralysis is reported. As spinal muscular atrophy is a progressive degenerative disorder of spinal anterior horn cells, with generalized neuromuscular weakness as a common sequela, the goal of anesthetic management is to provide satisfactory labor analgesia and anesthesia with minimal compromise of respiratory function. METHODS: A lumbar epidural anesthetic technique was used to provide satisfactory labor analgesia and anesthesia for a low forceps delivery. RESULTS: The anesthetic technique provided a safe delivery. As the patient was awake, she was able to assist with the expulsion phase of labor. The rare published reports of spinal muscular atrophy and obstetric management are reviewed, the known pertinent physiologic derangements of the syndrome in concert with pregnancy being detailed, along with any information provided regarding anesthetic techniques. CONCLUSIONS: It is believed that labor analgesia and anesthesia can be provided adequately with lumbar epidural techniques. An understanding of the physiology underlying spinal muscular atrophy is essential to safe anesthetic management of the laboring parturient.
BACKGROUND AND OBJECTIVES: A case of labor analgesia and anesthesia in a 23-year-old woman with spinal muscular atrophy and vocal cord paralysis is reported. As spinal muscular atrophy is a progressive degenerative disorder of spinal anterior horn cells, with generalized neuromuscular weakness as a common sequela, the goal of anesthetic management is to provide satisfactory labor analgesia and anesthesia with minimal compromise of respiratory function. METHODS: A lumbar epidural anesthetic technique was used to provide satisfactory labor analgesia and anesthesia for a low forceps delivery. RESULTS: The anesthetic technique provided a safe delivery. As the patient was awake, she was able to assist with the expulsion phase of labor. The rare published reports of spinal muscular atrophy and obstetric management are reviewed, the known pertinent physiologic derangements of the syndrome in concert with pregnancy being detailed, along with any information provided regarding anesthetic techniques. CONCLUSIONS: It is believed that labor analgesia and anesthesia can be provided adequately with lumbar epidural techniques. An understanding of the physiology underlying spinal muscular atrophy is essential to safe anesthetic management of the laboring parturient.