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Anaesthesia for Caesarean section in a patient with Watson’s syndrome

  • James B. Conway
  • Matthew Posner
Clinical Report

Abstract

Watson’s syndrome is an uncommon genetic disorder whose features include mental retardation and pulmonary valvular stenosis. The purpose of this report is to describe one management strategy used successfully to anaesthetize a woman with this disorder who presented for Caesarean section. Epidural anaesthesia using 0.5% bupivacaine without epinephrine in 2–3 ml boluses to a total dose of 15 ml was administered over 30 min. Invasive haemodynamic monitoring in the form of arterial and central venous catheters were used to guide therapy and help ensure maternal and fetal well-being. Intravenous ketamine in doses of 10–20 mg every five minutes to a total dose of 245 mg (4.5 mg · kg−1) was used to overcome the patient’s uncooperative nature and facilitate invasive procedures. Postoperative analgesia was provided using 3 mg epidural morphine. The patient was observed in the intensive care unit for the first postoperative day and experienced an uncomplicated intra- and postoperative course. We conclude that this technique represents a safe and effective method for anaesthetizing patients with this complicated problem for Caesarean section.

Key words

anaesthesia: obstetric Syndromes: Watson’s anaesthestics, intravenous: ketamine anaesthetic techniques: epidural 

Résumé

Le syndrome de Watson est une aberration génétique rare caractérisée principalement, entre autres, par un retard mental et une sténose de la valvule pulmonaire. Cette observation décrit la stratégie mise en oeuvre pour anesthésier une patiente porteuse de ce syndrome soumise à une césarienne. Une anesthésie épidurale est réalisée avec de la bupivacaïne 0,5% administrée en bolus de 2–3 ml sur une période de 30 min pour une dose totale de 15 ml. Le monitorage hémodynamique est constitué d’une tension veineuse centrale et d’une canule artérielle. De la kétamine iv aux doses de 10–20 mg aux cinq min pour un total de 245 mg (4,5 mg · kg−1) est administrée pour pallier à l’absence de collaboration et faciliter les mesures effractives. L’analgésie postopératoire est obtenue avec de la morphine épidurale 3 mg. La patiente est gardée sous observation à l’unité des soins intensifs pendant la journée qui suit l’intervention. Aucune complication ne survient pendant et après l’intervention. En conclusion, cette technique représente une méthode d’anesthésie efficace et non dangereuse pour effectuer une césarienne chez une patiente porteuse de ce désordre compliqué.

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Copyright information

© Canadian Anesthesiologists 1994

Authors and Affiliations

  • James B. Conway
    • 1
  • Matthew Posner
    • 1
  1. 1.Department of AnaesthesiaUniversity of Ottawa, Ottawa Civic HospitalOttawa

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