4. Beitrag ==► Subarachnoid Anesthesia

4. Beitrag (11.01.2012)…..ursprünglich eingestellt von Nicole
Subarachnoid Anesthesia for Cesarean Delivery in a Parturient with Strümpell-Lorrain Disease
Stéphane Deruddre, MD, Martine Marie, MD and Dan Benhamou, MD
+ Author Affiliations Département d’Anesthésie-Réanimation; Hôpital Antoine Béclère; Clamart, France; SOS Regional Anesthesia Hotline Service:; SOSalr@Free.Fr

We report the case of a 37-yr-old parturient with Strümpell-Lorrain disease or hereditary spastic paraparesis presenting for the preanesthetic evaluation visit for planned cesarean delivery. Hereditary spastic paraparesis is a rare, inherited neurodegenerative disease characterized by weakness, hyperreflexia, and progressive spasticity affecting lower limbs (1). The patient’s history included a previous cesarean delivery performed under general anesthesia, followed by worsening of her neurological symptoms.
We elected to proceed with spinal anesthesia. We placed a spinal needle at the L4-5 interspace with modest difficulty because of lumbar hyperlordosis. We injected a mixture of bupivacaine, sufentanil, and morphine. There was no paresthesia on injection. The block reached a T4 level. The cesarean delivery proceeded uneventfully, recovery was unremarkable, and there was no postoperative exacerbation of her disease.
The use of muscle relaxants is problematic in patients with paraparesis. Succinylcholine may induce hyperkalemia, and nondepolarizing muscle relaxants should be used with caution because of a possible exaggerated response (2). In addition, regional anesthesia has long been suspected to exacerbate neurological symptoms (3,4). However, prior reports have documented successful anesthetic management of patients with hereditary spastic paraparesis using general anesthesia (sevoflurane and N2O) (5) and epidural anesthesia (6). This case suggests that spinal anesthesia is also an option in these patients.
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5.↵ Kunisawa T, Takahata O, Takayama K, et al. Anesthetic management of a patient with hereditary spastic paraplegia [in Japanese]. Masui 2002;51:64–6. Medline
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