TITLE:
Successful Anaesthetic Management of Caesarean Section: An Experience on a Patient with Myasthenia Gravis and Difficult Airway
AUTHORS:
Akwasi Antwi-Kusi, William Addison, Elizabeth Esi Crentsil, Anthony Yeboah, Rex Mawuli Kwadjo Djokoto
KEYWORDS:
Myasthenia Gravis, Failed Spinal, Difficult Intubation, Second Generation Laryngeal Mask Airway
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.6,
June
3,
2019
ABSTRACT: The anaesthetic management of the pregnant woman with myasthenia gravis
(MG) is very challenging to the anaesthesiologist. This situation becomes exaggerated
in emergency settings in a low resource area, especially when attending
anesthesiologists for the first time took care of her. Here, we present a case
that illustrates this situation. A G3 P2 pregnant woman presented for an
emergency caesarean section (CS) due to premature rupture of the membranes. The
patient had been misinformed by her neurophysician not to undergo general
anaesthesia at CS. She had no motor weakness and no bulbar symtoms. The only
abnormal finding was a stiff neck and a Mallampati #2 score, which predicted a
difficult airway. Spinal anaesthesia was not successful after several attempts.
General anaesthesia was considered but again intubation was not successful. We
performed anesthesia with a second generation laryngeal mask airway with successful CS.
Pregnant women with MG require personalised care from a multidisciplinary team.
While regional anaesthesia is reported to be the better choice in CS for women
with MG, regional anesthesia is not always possible. Anesthesia should be
chosen in a patient-by-patient manner. The present case illustrates such
conditions, of which description may be useful for anesthesiologists and
obstetricians.