A pregnant woman with amyotrophic lateral sclerosis (ALS) successfully delivered her baby by cesarean section after receiving total intravenous anesthesia (TIVA) without muscle relaxant, in what Chinese researchers describe as a medical first.
ALS pregnancies are exceedingly rare to begin with, because the disease itself only affects two out of 100,000 inhabitants — more likely men than women — and because the onset of ALS usually occurs in the 50s and 60s, way past childbearing age.
The report, “Total intravenous anesthesia without muscle relaxant in a parturient with amyotrophic lateral sclerosis undergoing cesarean section: A case report,” appeared in the Journal of Clinical Anesthesia.
ALS is associated with loss of motor neurons, that is, neurons that control the muscles in the body. Researchers reported the case of a pregnant ALS patient presenting with motor deficiencies but that had a successful delivery after receiving appropriate TIVA, with no muscular relaxant associated.
The 27-year-old woman had been diagnosed with ALS 20 months before admission to Beijing’s Xuan Wu Hospital for a cesarean section in her 35th week of pregnancy. She had been receiving treatment with baclofen (5 mg daily). Her obstetrician had suggested an abortion, which led the patient to abandon all prenatal examinations.
Upon arrival, the patient had slurred speech and couldn’t walk. Medical examinations showed motor atrophy and weakness, as well as muscle stiffness and hyperreflexia (overresponsive reflexes) in the legs and arms. She also had limited vital and total lung capacity. During delivery, the woman received TIVA without muscle relaxant — a strategy that helped avoid prolonged ventilation and prevent maternal respiratory complications. She was discharged five days after surgery, with no signs of respiratory complications or other symptoms such as vomiting, nausea or aspiration occurring in the post-surgery period.
“The choice of anesthesia type in [pregnant women] with ALS undergoing cesarean section is controversial,” researchers wrote, adding that “this case report introduced a successful TIVA without muscle relaxant for a [pregnant woman] with ALS to prevent maternal complications during cesarean section. However, the efficacy of our strategies may be affected by selection bias because of the nature of case report. Further studies are therefore needed to confirm its efficacy.”
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