ANESTHESIA FOR CESAREAN-SECTION IN A PATIENT WITH MYOTONIC-DYSTROPHY RECEIVING WARFARIN THERAPY

A 31-yr-old parturient with myotonic dystrophy and asthma presented fo r elective Caesarean section. The patient was receiving warfarin havin g had two previous episodes of thromboembolism. Anticoagulation was su bsequently provided by heparin in the weeks prior to delivery. The com bination of the patient's medical conditions and the continuing need f or anticoagulation presented a considerable anaesthetic problem in pla nning anaesthesia and analgesia for both elective and emergency delive ry. Heparin was discontinued on the day prior to surgery and restarted immediately after surgery. During surgery flowtron anti-embolitic boo ts were used Warfarin therapy was recommenced on the seventh postopera tive day. Anaesthesia for Caesarean section was provided using a combi ned spinal epidural technique using a separate needle, separate inters pace method. Postoperative pain wells relieved by using a continuous e pidural infusion, transcutaneous nerve stimulation and diclofenac. No new neurological problems arose despite the use of epidural analgesia in the presence of heparin anticoagulation. This method of providing a naesthesia and postoperative analgesia without the use of opioids in a n anticoagulated, asthmatic, myotonic parturient has not been describe d elsewhere.