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Journal of Obstrectic Anaesthesia and Critical Care
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Year : 2018  |  Volume : 8  |  Issue : 1  |  Page : 58-59

Anaesthesia for an emergent caesarean section in a patient with acute transverse myelitis

Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, United States of America

Correspondence Address:
Dr. Samuel A Hunter
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai
United States of America
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joacc.JOACC_45_17

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We present a 32-year-old G1P0 woman at 32 weeks and two days gestation with new onset paraplegia, hyperreflexia, and sensory disturbance that gradually progressed over the past month and acutely worsened over the last 24 hours. MRI revealed a demyelinating process of the thoracic spine and diffuse cervicothoracic cord oedema. After 7 days, her foetus developed recurrent heart rate decelerations and an emergent caesarean section was performed. On airway exam, she was Mallampati 3 with a short thyromental distance. She reported fasting overnight and into the morning. Our choice was between performing neuraxial anaesthesia in the setting of an acute demyelinating process of her spinal cord versus general anaesthesia on a patient at risk of aspiration with a potentially difficult airway. Given the potential complications of neuraxial anaesthesia, we utilized rocuronium to perform a rapid sequence induction of general anaesthesia with endotracheal intubation.

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