COMBINED SPINAL AND EPIDURAL-ANESTHESIA FOR ABDOMINAL HYSTERECTOMY INA PATIENT WITH MYOTONIC-DYSTROPHY - CASE-REPORT

Background and Objectives. The authors report a case of myotonic dystr ophy in a 34-year-old woman who presented for total abdominal hysterec tomy. The goal of anesthetic management is to prevent the known trigge rs of myotonic crisis, such as hypothermia, shivering, and hyperkalemi a; and to avoid depolarizing muscle relaxants and anticholinesterase a gents. Methods. In this patient, the authors used combined spinal and epidural block for intraoperative anesthesia and postoperative analges ia. Results. The advantages of the combined technique offers rapid ons et and good muscle relaxation from subarachnoid block, with the abilit y to supplement analgesia through the epidural catheter both during an d after surgery. In addition, the potential complications associated w ith general anesthesia, including respiratory insufficiency, aspiratio n pneumonia, cardiac arrhythmia, and heart failure can be avoided. The other measures were directed toward the prevention of shivering, a co mmon problem encountered with general or regional anesthesia. Conclusi ons, After the postoperation, optimal analgesia was obtained by infusi ng local anesthetic (0.125% bupivacaine) via the epidural catheter. No obvious side effects occurred. The authors believe combined spinal an d epidural block provides a safe alternative, to other techniques, and minimizes the potential hazards of myotonic dystrophy, while offering effective intraoperative anesthesia and postoperative analgesia.