Anesthetic Management of a Parturient with Thalidomide Phocomelia英文文献资料.docVIP

Open Journal of Anesthesiology, 2012, 2, 59-61 1 /10.4236/ojanes.2012.23014 Published Online July 2012 (http://www.SciRP.org/journal/ojanes) Anesthetic Management of a Parturient with Thalidomide Phocomelia Samuel N. Blacker, Tiffany E. Angelo 1 Department of Anesthesiology, Womack Army Medical Center, Fort Bragg, USA; Department of Anesthesiology, Walter Reed 2 National Military Medical Center, Bethesda, USA. Email: Samuel.blacker@ Received April 10 , 2012; revised May 21 , 2012; accepted June 18 , 2012 th st th ABSTRACT The teratogenicity of thalidomide has been known since the early 1960s [1]. Thalidomide is currently used world wide, including the United States, to treat erythema nodosum leprosum, multiple myeloma, refractory Crohn’s disease, aphthous stomatitis and HIV wasting syndrome. New cases of thalidomide phocomelia are being reported as well. We report a case of the anesthetic challenges of a 23 year-old parturient with thalidomide phocomelia and review the im- portant anesthetic challenges it presents. Spontaneous vaginal delivery under continuous lumbar epidural was achieved in this challenging patient. However, it required careful planning for reliable intravenous access and the use of magnetic resonance imaging (MRI) of her pelvis and lumbar spine. Keywords: Anesthesia; Thalidomide Phocomelia; Obstertric Anesthesia 1. Introduction distance. She also had full range of motion in her cervical spine. The previous MRI of the pelvis was re-examined by the radiologist and was found to be devoid of evi- dence of lumbar vertebral abnormalities. Her hematocrit was 33.9 and platelet count was 254. The patient also had a history of von Willebrand’s disease but lacked antigen evidence upon her most recent testing. A 23 year-old G2 P0010 woman presented at 36 weeks gestation for an anesthetic