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Anesthetic management of a patient with spinocerebellar ataxia undergoing cesarean section
Abstract Number: T3D-3
Abstract Type: Case Report/Case Series
Spinocerebellar ataxia is collection of congenital motor disorders, which features progressive degenerative disease of the cerebellum and spinal cord causing neuromuscular, respiratory, and cardiovascular disturbances. The following is a summary of our anesthetic management of a grand multiparous parturient with spinocerebellar ataxia undergoing primary cesarean section for breech presentation. Anesthetic management included an epidural neuraxial technique and a transverse abdominis plane (TAP) block.
A 44 year old female G9P5036 at 39 weeks and 3 days presented for scheduled cesarean section due to breech presentation, complicated with history of autosomal recessive spinocerebellar ataxia-10 (SCAR10) characterized by 10 year progressively increasing difficulty with walking and phonating, digital numbness, and visual disturbances. Physical exam showed dysarthria, dysmetria, and dysdiadokinesis, as well as appendicular and gait ataxia with normal reflexes and extraocular movements. MRI at age 42 showed cerebellar atrophy and degeneration as well as a cavernous hemangioma in the left parietal lobe. External cephalic version of the fetus was attempted but unsuccessful, which prompted cesarean delivery. Preoperative consult with neurology advised against general anesthetic and narcotic use due to increase risk of postoperative delirium and respiratory depression. There was no perceived increased risk with neuraxial technique. Epidural was placed using loss of resistance technique. Test dose of 3cc of 1.5% lidocaine with epi 1:200,000 was negative and surgical anesthesia was achieved with a bolus of 15cc of 2% lidocaine with epi 1:200,000. After epidural placement, a TAP block was placed under ultrasound guidance by injecting with 15cc of 0.5% ropivacaine with 8 mg of dexamethasone bilaterally. Maintenance of anesthetic was achieved with intermittent epidural boluses of 2% lidocaine w/ epi. This allowed for adequate perioperative analgesia. Postoperatively, the patient’s pain was managed without the use of intravenous/oral opioids.
We safely administered a epidural neuraxial anesthetic along with a transverse abdominis plane (TAP) block in a patient with spinocerebellar ataxia for cesarean section. This proved to be a safe and effective method of providing anesthesia for such a patient population.