LABOR ANALGESIA AND ANESTHESIA IN A PATIENT WITH SPINAL MUSCULAR-ATROPHY AND VOCAL CORD PARALYSIS - A RARE AND UNUSUAL CASE-REPORT

Background and Objectives. A case of labor analgesia and anesthesia in a 23-year-old woman with spinal muscular atrophy and vocal cord paral ysis is reported. As spinal muscular atrophy is a progressive degenera tive disorder of spinal anterior horn cells, with generalized neuromus cular weakness as a common sequela, the goal of anesthetic management is to provide satisfactory labor analgesia and anesthesia with minimal compromise of respiratory function. Methods. A lumbar epidural anesth etic technique was used to provide satisfactory labor analgesia and an esthesia for a low forceps delivery. Results. The anesthetic technique provided a safe delivery. As the patient was awake, she was able to a ssist with the expulsion phase of labor. The rare published reports of spinal muscular atrophy and obstetric management are reviewed, the kn own pertinent physiologic derangements of the syndrome in concert with pregnancy being detailed, along with any information provided regardi ng anesthetic techniques. Conclusions. It is believed that labor analg esia and anesthesia can be provided adequately with lumbar epidural te chniques. An understanding of the physiology underlying spinal muscula r atrophy is essential to safe anesthetic management of the laboring p arturient.