Abstract
Purpose: To describe the anesthetic and obstetrical management of a pregnant patient with co-existing Familial Hypokalemic Periodic Paralysis (FHPP) and Wolff-Parkinson-White syndrome (WPW).
Clinical Features: A 29 yr-old primigravida with FHPP and WPW presented to the antenatal clinic at 18 wk gestation, for consideration of her anesthetic and obstetrical management during labour and delivery. A plan was constructed to avoid the known precipitating factors of FHPP including carbohydrate loading, cold, mental stress and exercise, which could lead to acute attacks of weakness. She presented for induction of labour at 41 wk and three days. An epidural catheter was sited early in labour. The second stage was limited to less than one hour. She had a rotational forceps delivery for which the epidural was extended to provide anesthesia. A healthy male baby was delivered. The patient made an uncomplicated recovery and was discharged home on the second postnatal day. The peripartum potassium was kept within the normal range with intravenous as well as oral potassium supplementation. No arrhythmias were reported.
Conclusion: Assessment of the patient at an early stage in her pregnancy allowed for a multidisciplinary approach to this patient and her medical problems. A plan was made to avoid known precipitating factors during labour, delivery and the postnatal period well in advance of her date of confinement, leading to a successful outcome for mother and child.
Résumé
Objectif: Décrire le traitement anesthésique et obstétrical d’une patiente enceinte atteinte d’une paralysie périodique hypokaliémique familiale (PPHF) et du syndrome de Wolff-Parkinson-White (WPW).
Éléments cliniques: Une primigeste de 29 ans atteinte de PPHF et du syndrome de WPW a été vue à la clinique prénatale à 18 sem de grossesse pour que soit envisagé le déroulement anesthésique et obstétrical du travail et de l’accouchement. Cette planification visait à prévenir les facteurs déclenchants de la PPFH, comme la charge glucidique, le froid, le stress mental et l’exercice, qui pourraient entraîner une faiblesse aiguë. À 41 sem et 3 jrs de grossesse, on a procédé à l’induction du travail. On a placé un cathéter péridural tôt pendant le travail actif. Le deuxième stade a duré moins d’une heure. L’accouchement a nécessité une rotation par l’application de forceps et une extension de l’anesthésie. La patiente a donné naissance à un garçon en santé, a connu une récupération sans complications et a quitté l’hôpital le deuxième jour postnatal. Pendant la période périnatale, le potassium a été maintenu dans les limites de la normale grâce à des suppléments intraveineux et oraux. Aucune arythmie n’a été notée.
Conclusion: L’évaluation de la grossesse à un stade précoce a permis le traitement multidisciplinaire de la patiente et de sa condition médicale. Le plan élaboré, bien avant la date prévue de l’accouchement, pour prévenir les facteurs déclenchants de la maladie pendant la période périnatale a mené à d’heureux résultats pour la mère et l’enfant.
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Robinson, J.E., Morin, V.I., Douglas, M.J. et al. Familial hypokalemic periodic paralysis and wolff-parkinson-white syndrome in pregnancy. Can J Anaesth 47, 160–164 (2000). https://doi.org/10.1007/BF03018853
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DOI: https://doi.org/10.1007/BF03018853