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Successful Anaesthetic Management of Caesarean Section: An Experience on a Patient with Myasthenia Gravis and Difficult Airway

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Open Journal of Obstetrics and Gynecology 2019年第6期9卷 789-793页

作者： Akwasi Antwi-Kusi William Addison elizabeth esi crentsil Anthony Yeboah Rex Mawuli Kwadjo Djokoto Department of Anaesthesiology Komfo Anokye Teaching Hospital Kumasi Ghana Department of Obstetrics and Gynaecology Komfo Anokye Teaching Hospital Kumasi Ghana

The anaesthetic management of the pregnant woman with myasthenia gravis (MG) is very challenging to the anaesthesiologist. This situation becomes exaggerated in emergency settings in a low resource area, especially when attending anesthesiologists for the first time took care of her. Here, we present a case that illustrates this situation. A G3 P2 pregnant woman presented for an emergency caesarean section (CS) due to premature rupture of the membranes. The patient had been misinformed by her neurophysician not to undergo general anaesthesia at CS. She had no motor weakness and no bulbar symtoms. The only abnormal finding was a stiff neck and a Mallampati #2 score, which predicted a difficult airway. Spinal anaesthesia was not successful after several attempts. General anaesthesia was considered but again intubation was not successful. We performed anesthesia with a second generation laryngeal mask airway with successful CS. Pregnant women with MG require personalised care from a multidisciplinary team. While regional anaesthesia is reported to be the better choice in CS for women with MG, regional anesthesia is not always possible. Anesthesia should be chosen in a patient-by-patient manner. The present case illustrates such conditions, of which description may be useful for anesthesiologists and obstetricians.

关键词： Myasthenia Gravis Failed Spinal Difficult Intubation Second Generation Laryngeal Mask Airway

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