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Anesthetic management of a ventilator-dependent parturient with the King-Denborough syndrome

[La prise en charge anesthésique d’une parturiente en ventilation assistée intermittente, atteinte du syndrome de King-Denborough]

From the Division of Women’s Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.

Address correspondence to: Dr. Ashraf S. Habib, Division of Women’s Anesthesia, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA. Phone: 919-681-6535; Fax: 919-668-6265; E-mail: habib001{at}mc.duke.edu

Purpose: The King-Denborough syndrome (KDS) is a rare disorder that is associated with myopathy, susceptibility to malignant hyperthermia (MH) as well as congenital skeletal and facial anomalies. We report the anesthetic management of a parturient with KDS.

Clinical features: We describe the management of a 24-yr-old primiparous woman with a diagnosis of KDS and a history of previous MH reaction (age two). Her KDS resulted in chronic respiratory failure. She had a permanent tracheostomy and required overnight ventilatory support for the previous two years. She had three admissions during her pregnancy, one for pneumonia and two for preterm labour. Labour was induced at 37 weeks. Her labour was managed in the operating room where a "clean" anesthesia machine was ready. Cooling aids and a MH emergency kit were immediately available. Intravenous access, an arterial line and a lumbar epidural catheter were inserted before induction of labour.

Ropivacaine 0.08% + fentanyl 2 µg•mL^-1 were used for patient-controlled epidural analgesia. After 6.5 hr of labour the patient required ventilation. An outlet forceps was performed for delivery. Postpartum, she was ventilated overnight in the intensive care unit.

Conclusion: The use of epidural analgesia, close monitoring and collaboration between the various disciplines were important in achieving a safe and uneventful labour in this high-risk parturient.

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