Anesthesia for Cesarean section in a patient with paraplegia resulting from tumour metastases to spinal cord

Purpose: Spinal cord injured patients present multiple unique challenges to the anesthesiologist. These include choice of muscle relaxant and manageme nt of autonomic hyperreflexia, We report the anesthetic management for Cesa rean delivery in a patient who was paraplegic due to spinal canal metastase s. Preeclampsia and fever complicated this case. Clinical features: The patient presented at 29 wk gestation with progressiv e paraplegia at the T-10 level due to metastatic osteosarcoma. She had a de compressive laminectomy without improvement in her paralysis. She subsequen tly developed preeclampsia at 31 wk gestation, and underwent Cesarean deliv ery for breech presentation under general anesthesia. Anatomical concerns l eft us unsure of the efficacy or safety of neuraxial anesthesia, Conclusions: Preeclampsia and autonomic hyperreflexia are generally indicat ions for regional anesthesia for Cesarean section. Tumour in her spinal can al and laboratory abnormalities including thrombocytopenia and a potential urosepsis dissuaded us from this option. Additionally, rapid sequence induc tion and intubation were not preferred due to paraplegia, leading us to sec ure the airway fibreoptically.