Combined spinal epidural anesthesia for cesarean section in a patient withleft lung agenesis

(A)genesis of the lung is a rare developmental defect characterized by comp lete absence of one lung, or hypoplasia of one or both lungs, The majority of reported cases have been associated with other congenital anomalies. It is usually detected in childhood as a result of either pulmonary symptoms o r associated anomalies. Although pulmonary agenesis has been reported in ad ults, there is no report of the management of a pregnant patient for cesare an section in the anesthetic literature. We report the management of a 23-y ear-old pregnant female at 36 weeks' gestation with oligohydramnios and lef t lung agenesis for elective cesarean section. She presented with a history of repeated chest infection and was found to have restrictive lung functio n. She had no other congenital anomalies. Combined spinal epidural anesthes ia was administered for cesarean section. The intraoperative course was une ventful except for bradyarrhythmias followed by tachyarrhythmias on manipul ation of the uterus. She was given low dose epidural morphine with local an esthetic and intramuscular diclofenac for postoperative analgesia. We belie ve that normal pregnancy can safely be undertaken in the presence of left l ung agenesis, In view of associated congenital anomalies in more than 50% o f the cases, anesthetic management should include a particularly careful su rvey of other systems. The patient should otherwise be managed like any pat ient with limited pulmonary reserve. Combined spinal epidural anesthesia is safe and appropriate for such patients. (C) 2001 Harcourt Publishers Ltd.