Successful Spinal Anesthesia for Cesarean Section in a Patient With Marfan Syndrome Complicated by Dural Ectasia

(Int J Obstet Anesth. 2018;35:88–92) Marfan syndrome (MFS) is an autosomal dominant condition characterized by connective tissue abnormalities across multiple systems. Patients with MFS may have a dilated aortic root, and this can place the parturient at increased risk during labor and delivery. Cesarean delivery is sometimes recommended for women with MFS who have an aortic root diameter>40 mm. However, reduced effectiveness of spinal anesthesia has been reported in some patients with MFS. The failure is thought to possibly be related to the dural ectasia that is present in many patients with MFS; this may lead to incomplete cephalad distribution of intrathecal local anesthetic. This case report detailed a parturient who was undergoing her second cesarean delivery after failed neuraxial anesthesia during her first delivery, with the author postulating that warmed isobaric bupivacaine, injected as far away as possible from the ectatic dural sac, may be able to overcome inconsistent intrathecal distribution.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Case Reports Source Type: research