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Canadian Journal of Anesthesia, Vol 45, 332-336, Copyright © 1998 by Canadian Anesthesiologists' Society

ARTICLES

Anaesthesia in a parturient with Noonan's syndrome

CS Grange, R Heid, SB Lucas, PL Ross and MJ Douglas
Department of Anaesthesia, University of British Columbia.

PURPOSE: To report the management of labour analgesia and subsequent anaesthesia for postpartum bleeding in a 19-yr-old parturient with Noonan's syndrome. CLINICAL FEATURES: The patient presented in active labour at 36-wk gestation. She was known to have Noonan's syndrome and had been assessed regularly throughout pregnancy. Features of the syndrome exhibited by the patient included typical facies, chest skeletal abnormalities, pulmonary valve dysplasia, mental retardation and lymphoedema. In addition, she had Factor XI deficiency (0.46 mg.L-1) and thrombocytopenia (92 x 10(9).L-1), previously unreported in a parturient with this syndrome. Although epidural analgesia may have been considered the labour analgesic technique of choice, the risk of epidural haematoma caused by her bleeding diathesis made this unacceptable. This risk was balanced against the possibility of a potentially difficult intubation due to facial abnormalities, should emergency operative delivery become necessary. Labour analgesia was provided with intravenous patient controlled opioid analgesia (fentanyl 25 micrograms bolus, five minute lockout) despite her mental retardation. Dilatation and curettage required general anaesthesia after intubation with awake direct laryngoscopy using cautious sedation. CONCLUSION: Noonan's syndrome is characterised by multi-system involvement, requiring thorough preoperative assessment of cardiovascular, skeletal, haematological and central nervous systems. Clotting and platelet defects considerably restrict the possible analgesic and anaesthetic options for labouring patients with this syndrome.


This article has been cited by other articles:


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 Canadian J. AnesthesiaHome page
J. McBain, E. G. Lemire, and D. C. Campbell
Epidural labour analgesia in a parturient with Noonan syndrome: a case report: [Analgesie peridurale chez une parturiente atteinte du syndrome de Noonan : une presentation de cas].
Can J Anesth, March 1, 2006; 53(3): 274 - 278.
[Abstract] [Full Text] [PDF]

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 Obstet GynecolHome page
A. J. Cullimore, K. G. Smedstad, and B. G. Brennan
PREGNANCY IN WOMEN WITH NOONAN SYNDROME: REPORT OF TWO CASES
Obstet. Gynecol., May 1, 1999; 93(5): 813 - 816.
[Abstract] [Full Text] [PDF]


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Copyright © 1998 by the Canadian Anesthesiologists' Society.