Ward V D
Department of Peri-Operative Medicine, Coombe Womens & Infants University Hospital, Dublin, Ireland.
Int J Obstet Anesth. 2018 May;34:99-102. doi: 10.1016/j.ijoa.2017.11.003. Epub 2017 Nov 21.
Parkinson's disease is prevalent worldwide but mainly affects the elderly and is rarely seen in women of child-bearing age. The clinical signs and symptoms, the physiological changes of pregnancy, and drug interactions, pose unique challenges for the anaesthetic management of patients with Parkinson's disease who present for delivery. A 36-year-old primigravid woman at 36 weeks' gestation, with Parkinson's disease, presented for pre-anaesthesia assessment prior to elective caesarean section. Her Parkinson's disease had been diagnosed four years previously and was treated with Sinemet (levodopa/carbidopa) and pramipexole. Despite maximum allowable drug doses in pregnancy, she reported disease progression, with right-sided weakness in the upper and lower limbs and an altered gait. Spinal anaesthesia for elective Caesarean section was performed in the sitting position, using 0.5% hyperbaric bupivacaine, morphine 150 µg and fentanyl 25 µg. The anaesthesia and Caesarean section were uneventful. She was discharged home with a healthy baby on the fourth postoperative day.
帕金森病在全球范围内普遍存在，但主要影响老年人，在育龄妇女中很少见。帕金森病患者分娩时的临床体征和症状、妊娠的生理变化以及药物相互作用，给麻醉管理带来了独特的挑战。一名36岁、孕36周的初产妇，患有帕金森病，在择期剖宫产术前进行麻醉前评估。她的帕金森病在4年前被诊断出来，目前使用息宁（左旋多巴/卡比多巴）和普拉克索进行治疗。尽管在孕期使用了最大允许剂量的药物，但她仍报告病情进展，出现上肢和下肢右侧无力以及步态改变。择期剖宫产采用坐位脊麻，使用0.5%的高压布比卡因、150μg吗啡和25μg芬太尼。麻醉和剖宫产过程顺利。术后第四天，她带着健康的婴儿出院回家。
