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CASE REPORT
Year : 2015  |  Volume : 14  |  Issue : 1  |  Page : 74-78

Thoracic epidural anaesthesia for laparoscopic cholecystectomy in patient with type Iv spinal muscular dystrophy


Dept. of Anaesthesia & Intensive Care Unit, Al-Yarmouk Teaching Hospital

Correspondence Address:
Zinah Majid Mnati
Dept. of Anaesthesia & Intensive Care Unit, Al-Yarmouk Teaching Hospital

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Source of Support: None, Conflict of Interest: None


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Spinal muscular atrophy (SMA) is a rare genetic neurodegenerative disease characterized by degeneration of spinal cord lower motor neurons, which results in atrophy of skeletal muscles, hypotonia and muscle weakness. Patients with type IV SMA often have onset of weakness at adulthood. Anesthetic management is often difficult in these patients as a result of muscle weakness and hypersensitivity to neuromuscular blocking agents also succinylcholine induced hyperkalemia, postoperative intensive care unit admission and long hospital stay. Laparoscopic surgery is normally performed under general anesthesia, but regional techniques have been found beneficial, usually in the management of patients with major medical problems. The goals for anesthetic management of these patients include satisfactory anesthesia during surgery, excellent postoperative analgesia with minimal compromise of respiratory function without exacerbation of neurologic signs and symptoms. We describe a 37-year-old male patient with type IV SMA scheduled for laparoscopic cholecystectomy. We decided to use an epidural technique to avoid muscle relaxants, tracheal intubation and to evaluate the efficacy and feasibility of thoracic epidural anesthesia for laparoscopic cholecystectomy, so that it can be used later as Anesthetic technique in patients when general anesthesia is not feasible. After operation, there was no exacerbation of neurologic signs and symptoms or development of respiratory complications neither a need for intensive care unit admission.


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