Spinal anesthesia for cesarean section in a patient with Ehlers-Danlos syndrome, classical subtype: a case report

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Vol 5 | Issue 2 | May-Aug 2019 | page: 10-12  | Alberto Pastore, Francesca Piccini


Authors: Alberto Pastore [1], Francesca Piccini [2]

[1] Department of Anesthesia and Intensive Care, University of Pisa, Stabilimento di
Cisanello, via Paradisa 2, 56124, Pisa, Italy.
[2] Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera
Universitaria Pisana, Stabilimento di Santa Chiara, via Roma 67, 56126, Pisa, Italy.

Address of Correspondence

Dr. Alberto Pastore,
Department of Anesthesia and Intensive Care, University of Pisa, Stabilimento di
Cisanello, via Paradisa 2, 56124, Pisa, Italy.
E-mail address: alberto.pastore@gmail.com


Abstract

Ehlers-Danlos syndrome includes thirteen subtypes, with different characteristics and clinical implications. There are no guidelines to help clinicians managing patients affected by this syndrome, but from 2014 recommendations exist. These patients have an increased anesthetic risk, both for general and regional technique. We describe the choice of anesthesia in a 34 years old pregnant woman, affected by Ehlers-Danlos syndrome classical subtype, who underwent cesarean section. Literature shows case reports about pregnancy and delivery in different subtypes, but not in classical one. We chose to perform a spinal block, with success.

Keywords: Ehlers-Danlos syndrome, Classical subtype, Pregnancy, Cesarean section, Spinal anesthesia.


References

1. Malfait F, Francomano C, Byers P, et al. The 2017 international classification of the Ehlers–Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017; 175C: 8–26.
2. The Ehlers-Danlos Society. https://www.ehlers-danlos.com/what-is-eds/. Accessed February 4, 2018.
3. Wiesmann T, Castori M, Malfait F, Wulf H. Recommendations for anesthesia and perioperative management in patients with Ehlers-Danlos syndrome(s). Orphanet J of Rare Dis. 2014; 9: 109.
4. Bowen JM, Sobey GJ, Burrows NP, et al. Ehlers–Danlos syndrome, classical type. Am J Med Genet C Semin Med Genet. 2017; 175C: 27–39.
5. Traynor AJ, Aragon M, Ghosh D, et al. Obstetric anesthesia workforce survey: a 30 year update. Anesth Analg. 2016; 122: 1939–1946.
6. Abir G, Mhyre J. Maternal mortality and the role of obstetric anesthesiologist. Best Pract Res Clin Anaesthesiol. 2017 Mar; 31(1): 91-105.
7. Volkov N, Nisenblat V, Ohel G, Gonen R. Ehlers-Danlos syndrome: insights on obstetric aspects. Obstet Gynecol Surv. 2007; 62: 51–7.
8. Anaesthesia recommendations for patients suffering from Ehlers-Danlos Syndrome. Available at: http://www.orphananesthesia.eu/en/rarediseases/ published-guidelines/cat_view/61-rare-diseases/60-publishedguidelines/ 89-ehlers–danlos-syndrome.html. Accessed February 4, 2018.
9. Sood V, Robinson DA, Suri I. Difficult intubation during rapid sequence induction in a parturient with Ehlers-Danlos syndrome, hypermobility type. Int J Obstet Anesth. 2009 Oct; 18(4): 408-12.
10. Saravanakumar K, Rao SG, Cooper GM. The challenges of obesity and obstetric anaesthesia. Curr Opin Obstet Gynecol. 2006; 18: 631–635.
11. Goldstein M, Miller R. Anesthesia for cesarean delivery in a patient with Ehlers-Danlos syndrome type II. Reg Anesth. 1997; 22: 280-283.
12. Kuczkowski KM, Benumof JL. Cesarean section and Ehlers-Danlos syndrome: choise of anesthesia. Int J Obstet Anesth. 2002; 11: 222-224.
13. Fernández-García R, Ramos-Zabala A, Pérez-Mencía T, Sanz-Baena C, López-García A. Subarachnoid anesthesia for cesarean section in a patient with Ehlers-Danlos syndrome type II. Rev Esp Anestesiol Reanim. 2004 May; 51(5): 268-71.
14. Arendt-Nielsen L, Kaalund S, Bjerring P, Hogsaa B. Insufficient effect of local analgesics in Ehlers-Danlos type III patients (connective tissue disorder). Acta Anaesthesiol Scand. 1990; 34: 358–61.
15. Hakim AJ, Grahame R, Norris P, Hopper C. Local anaesthetic failure in joint hypermobility syndrome. JRSM. 2005 Feb; 98(2): 84–5.


How to Cite this Article: Pastore A, Piccini F. Spinal anesthesia for cesarean section in a patient with Ehlers- Danlos syndrome, classical subtype: a case report. Journal of Anaesthesia and Critical Care Case Reports May-Aug 2019; 5(2):10-12. 

 


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