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Can J Anesth/J Can Anesth (2012) 59:10521057
DOI 10.1007/s12630-012-9778-5
CASE REPORTS/CASE SERIES
Regional anesthesia in Marfan syndrome, not all dural ectasias are the same: a report of two cases
Anesthsie rgionale dans le syndrome de Marfan;toutes les ectasies de la dure-mre ne se ressemblent pas : unetude de deux cas
Leyla Baghirzada, MD Timo Krings, MD, PhD
Jose C. A. Carvalho, MD, PhD
Received: 20 July 2012 / Accepted: 21 August 2012 / Published online: 14 September 2012 Canadian Anesthesiologists Society 2012
AbstractBackground The anesthetic management of women with Marfan syndrome and dural ectasia undergoing Cesarean delivery remains controversial. We present two cases of patients with Marfan syndrome and dural ectasia where neuraxial anesthesia was used successfully.
Case 1 A 31-yr-old G1P0 female with Marfan syndrome presented for elective Cesarean delivery at 353/7 weeks
gestation. The magnetic resonance imaging of her spine revealed signicant dural ectasia in the lumbosacral area with a mean lumbar dural sac area of 4.71 cm2. Intrathecal administration of 0.75% hyperbaric bupivacaine 9 mg produced only limited perineal analgesia. The epidural catheter was titrated, and 0.5% bupivacaine 150 mg were required to achieve a T4 sensory level.
Case 2 A 34-yr-old G1P0 female with Marfan syndrome presented for elective Cesarean delivery at 37 weeks gestation. The intrathecal administration of 0.75%
hyperbaric bupivacaine 13.5 mg produced a T5 sensory level. Magnetic resonance imaging of her spine prior to discharge conrmed the diagnosis of moderate dural ectasia with a mean lumbar dural sac area of 3.61 cm2.
Discussion The two patients described in this report responded differently to spinal anesthesia, most likely based on the severity of their dural ectasia. Although preoperative magnetic resonance imaging may help to identify patients at risk for a failed spinal, we suggest considering a combined spinal-epidural technique in cases of dural ectasia.
RsumContexte La prise en charge anesthsique de femmes ayant un syndrome de Marfan et une ectasie de la dure-mre au cours dun accouchement par csarienne reste un sujet controvers. Nous prsentons le cas de deux patientes ayant un syndrome de Marfan et une ectasie de la dure-mre chez qui une anesthsie neuraxiale a t ralise avec succs. Cas n8 1 Une femme de 31 ans, G1P0, ayant un syndrome de Marfan a t admise...