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Anesthetic management of a parturient with carnitine palmitoyltransferase II deficiency

[Anesthésie d’une parturiente qui présente un déficit en carnitine palmitoyltransférase II]

From the Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Eric Goldszmidt, Mount Sinai Hospital, 600 University Avenue #1514, Toronto, Ontario M5G 1X5, Canada. Phone: 416-586-5270; Fax: 416-586-8664; E-mail: e.goldszmidt{at}utoronto.ca

Purpose: To report the anesthetic management of a patient with carnitine palmitoyltransferase II deficiency who presented for labour and delivery.

Clinical features: A 30-yr-old primiparous woman with known carnitine palmitoyltransferase II deficiency and a past history of exercise induced muscle pain, weakness and myoglobinuria presented in active labour. Management consisted of an early epidural for labour and continuous dextrose infusion with frequent blood sugar monitoring. She had an uneventful spontaneous vaginal delivery. She experienced a single asymptomatic episode of hypoglycemia on the first postpartum day. Her serum creatine kinase was six times normal at 24 hr post-delivery and remained elevated for three days without evidence of rhabdomyolysis. The remainder of her postpartum course was uneventful.

Conclusion: Labour and delivery is a potential precipitant of rhabdomyolysis in patients with carnitine palmitoyltransferase II deficiency. The normal postpartum creatine kinase elevation (two to four times baseline at 24 hr) must be taken into account when monitoring these patients. On the basis of the physiologic principles, institution of early epidural analgesia to blunt the stress response to labour and delivery, continuous dextrose infusion and frequent glucose monitoring during labour and postpartum are the mainstays of management.