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COMBINED SPINAL EPIDURAL ANAESTHESIA IN A PREGNANT PATIENT WITH SCLERODERMA: CASE REPORT
ESRA Academy. Çok OY. Sep 8, 2016; 138598; 0479 Topic: Obstetric Population
Assoc. Prof. Oya Yalçın Çok
Assoc. Prof. Oya Yalçın Çok

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Abstract
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Background and Aims:

Scleroderma is a multi systemic disease characterised by fibrosis in skin, blood vessels and internal organs. General anaesthesia is technically challenging due to systemic involvement and related deformities such as restricted mouth opening, limited joint and difficult airway. Besides prolonged sensory and motor blockade sustained effects would be achieved during regional anaesthesia. Here, we present the management of a pregnant patient with scleroderma under combined spinal epidural (CSE) anaesthesia.

Methods:

A 37-years-old, 36 weeks gestational age pregnant patient was scheduled for emergency caesarean section due to abnormal uterine dystosis. She was diagnosed with scleroderma and under the treatment of nifedipine and metylprednisolon. Physical examination revealed waxy, smooth and tight skin, small chin, decreased oral aperture, mild flexion contractures of fingers. Laboratory values were within normal ranges and CSE anaesthesia was planned.

Results:

Epidural catheter was inserted for the management of postoperative pain and spinal anaesthesia with hyperbaric bupivacaine 0.5% 12.5 mg+10 mcg fentanyl was preferred for surgical anaesthesia. The perioperative period was uneventful and prolonged sensorial and motor blockade was not observed postoperatively.

Conclusions:

In this report we described the successful and safety use of CSE technique in a pregnant patient with scleroderma. The anaesthetic technique should be examined for  potential disadvantages  after separate evaluation of the pregnant patient, the disease and the surgical procedure and decision should be made on an individualised bases. We suggest that CSE anaesthesia would be performed in patients with scleroderma even though the technique have the possibility of  prolonged sensorial and motor blockade

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