McTiernan C, Haagenvik B
Department of Anesthesiology and Intensive Care, Haugesund General Hospital, Norway.
Can J Anaesth. 1999 Jul;46(7):679-82. doi: 10.1007/BF03013958.
The anesthetic management of a parturient with Strumpell's disease (hereditary or familial spastic paraparesis) who presented for Cesarean section is described. This neurological disorder is briefly reviewed and anesthetic implications of the condition are discussed.
A 30-yr-old woman in premature labour presented for Cesarean section. She had bilateral lower limb spastic paresis which had resulted in her being confined to a wheelchair from the age of 13 yr. A diagnosis of Strumpell's disease had been made in childhood. She was currently receiving thromboprophylaxis, having suffered a deep venous thrombosis four weeks after a previous Cesarean section. The patient was in mild respiratory distress. Despite a history of uneventful general anesthesia and the aforementioned complicating factors, epidural anesthesia was considered the most appropriate technique in these circumstances. An epidural catheter was sited at the L3-L4 interspace. Adequate anesthesia for the procedure was obtained after administration of 20 ml lidocaine 2% with 100 microg epinephrine and 100 microg fentanyl in saline. Postoperatively and at six month follow-up there were no neurological complications related to the use of epidural anesthesia.
Strumpell's disease is an inherited progressive spastic paresis predominantly affecting the lower extremities. Epidural anesthesia appears to be an appropriate technique when administering anesthesia for Cesarean section under similar circumstances.
描述一例因剖宫产就诊的患有施特吕姆佩尔病（遗传性或家族性痉挛性截瘫）产妇的麻醉管理。简要回顾了这种神经疾病，并讨论了该病症的麻醉相关问题。
一名30岁早产产妇因剖宫产就诊。她双侧下肢痉挛性轻瘫，自13岁起就只能依靠轮椅行动。童年时被诊断为施特吕姆佩尔病。她目前正在接受血栓预防治疗，因为之前剖宫产术后四周曾发生过深静脉血栓形成。患者有轻度呼吸窘迫。尽管有全身麻醉过程顺利的病史以及上述复杂因素，但在这种情况下，硬膜外麻醉被认为是最合适的技术。在L3 - L4椎间隙置入硬膜外导管。在给予20毫升含100微克肾上腺素和100微克芬太尼的2%利多卡因生理盐水溶液后，获得了该手术足够的麻醉效果。术后及六个月随访时，未出现与硬膜外麻醉使用相关的神经并发症。
施特吕姆佩尔病是一种主要影响下肢的遗传性进行性痉挛性轻瘫。在类似情况下，硬膜外麻醉似乎是剖宫产麻醉的合适技术。
