Document Detail


Anaesthetic management of labour and delivery in the parturient with mitochondrial myopathy.
MedLine Citation:
PMID:  8697558     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We describe the anaesthetic management for Caesarean section in a parturient with a defect in complex III of the respiratory chain who had increased lactate concentrations at rest and with exercise. CLINICAL FEATURES: We administered effective epidural anaesthesia with lidocaine for Caesarean delivery. The serum lactate concentration was less than the preoperative value both during and after surgery. Shivering during the perioperative period was avoided by administering warm i.v. fluids, warm local anaesthetic solution and epidural meperidine. Pain relief after surgery was provided with i.v. PCA morphine augmented by local infiltration with bupivacaine to fascia and skin edges and epidural injection with meperidine. CONCLUSION: Mitochondrial myopathies are an uncommon group of disorders in which mitochondrial dysfunction leads to clinical disease of muscle and sometimes of other organs with high energy requirements. The management of labour and delivery in women with mitochondrial myopathies should be individualized according to severity of disease and formulated by consultation between attending physicians and the anaesthetist. Epidural analgesia reduces stress and work associated with labour and reduces oxygen demand during labour. However, parturients with defects of the respiratory chain with documented increased lactate concentrations at rest and with exercise are best managed with elective Caesarean delivery with regional anaesthesia to prevent life-threatening lactic acidosis during labour. The association between malignant hyperthermia and these disorders has not been proved, but it appears prudent to consider these women as MH susceptible until definitive data regarding this possible relationship are available.
Authors:
O P Rosaeg; S Morrison; J P MacLeod
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  43     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  1996 Apr 
Date Detail:
Created Date:  1996-09-05     Completed Date:  1996-09-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  403-7     Citation Subset:  IM    
Affiliation:
Department of Anaesthesia, Ottawa Civic Hospital, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Obstetrical*
Female
Humans
Mitochondrial Myopathies / physiopathology*
Pregnancy
Pregnancy Complications / physiopathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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