///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-06:00

A Case of Central Hypoventilation Syndrome in a Pregnant Patient

Abstract Number: 64
Abstract Type: Case Report/Case Series

Angel m Martino-Horrall M.D., B.A1

Introduction: Central Hypoventilation Syndrome (CHS), also known as Ondines Curse, is a rare condition characterized by episodes of sustained Hypoventilation, Hypercarbia, and Hypoxemia during sleep. It is a syndrome of varying symptom severity with little literature published regarding its anesthetic management.

Case Report: A 31 year old, G3P1 parturient at 39 weeks gestation, with known CHS, presented with severe Pre-eclampsia. Intravenous Magnesium infusion was started and labor was induced with intravenous Pitocin. She delivered a healthy 3045g baby girl 6 hours later, assisted by forceps with epidural analgesia. Anesthetic management included reduction of epidural Fentanyl from 100mcg to 25 mcg, and post-operative monitoring in the high risk unit with continuous pulse oximetry.

The patient remained stable for 12 hours, but then began experiencing increasing labial pain treated by her obstetric team with intravenous Toradol and repeated escalating doses of intravenous Morphine. At 24 hours post-partum, the patient was found apneic and unresponsive with SpO2 29%. Blood pressure and heart rate were stable. The patient was immediately ventilated with 100% oxygen and subsequently intubated. Narcan was administered and the patient responded by immediate SpO2 return to 99%. Physical Exam revealed a 10cm labial hematoma and Arterial Blood Gas showed severe respiratory acidosis with PCO2 of 99. Chest Xray, EKG and routine labs revealed no abnormality.

The patient was transported to the ICU where she was extubated that evening. Further management included CPAP at night and non-narcotic pain control. The patient was discharged from the ICU the following day. She returned to the hospital for hematoma evacuation 2 days later and underwent a successful spinal anesthetic with an uneventful recovery in the ICU.

Discussion: CHS exists in a congenital or familial form, and a secondary form. Regardless of etiology, clinical characteristics are the same. Thus, even though it is a rare disorder, it has significant anesthetic implications and warrants a working knowledge and diligent management by the anesthetic team caring for these patients. Sensitivity to respiratory depressants, such as narcotics, delayed awakening after an anesthetic, and the possible need for prolonged ventilatory support post-operatively are important considerations that should be addressed. Also, the anesthesiologist must have a low threshold for re-intubating a patient that remains somnolent and/or hypoventilatory post-operatively. Regional anesthesia is recommended when applicable. Many patients with this condition are ventilator-dependant during sleep, which was not the case in our patient, but nonetheless should be considered in patients presenting with a family history of such disease processes or similar signs/symptoms. When properly managed, these patients can have a successful perioperative course, as did our patient in her second operation and recovery.

SOAP 2009