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Canadian Journal of Anesthesia, Vol 32, 418-421, Copyright © 1985 by Canadian Anesthesiologists' Society

Caesarean Section for Twins in a Patient with Myotonic Dystrophy

R. A. PATERSON MD1, M. TOUSIGNANT MD, FRCPC1, and D. S. SKENE MD, FRCPC1

1 Department of Anaesthesia, Ottawa General Hospital Ottawa, Ontario

Address correspondence to: Dr. R.A. Paterson, Department of Anaesthesia, Ottawa General Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6.

The management of a patient with myotonic dystrophy undergoing Caesarean section for delivery of twins in breech position is reported. Anaesthetic management must reflect the multi-system nature of the disease in addition to the implications of pregnancy. Known triggers of myotonic crisis (succinylcholine, shivering) must be avoided. Attention to respiratory reserve is necessary in view of the restrictive defect this disease can impose. Cardiomyopathy and conduction system disturbances may be features. Upper gastrointestinal incoordination can superimpose the added risk of aspiration on the pregnant myotonic. Ineffective uterine contraction can cause vigorous post partum haemorrhage. Endocrine disturbances, especially diabetes mellitis, may be present. There may be increased sensitivity to sedative and narcotic agents. The newborn myotonic will need the expertise of neonatal care.

Key Words: ANAESTHESIA: obstetric • SURGERY: Caesarean Section • GENETIC FACTORS: myotonic dystrophy






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Copyright © 1985 by the Canadian Anesthesiologists' Society.