title: Combined spinal and epidural anesthesia for abdominal hysterectomy in a patient with myotonic dystrophy. Case report.
abstract: OBJECTIVE
  The authors report a case of myotonic dystrophy in a 34-year-old woman who presented for total abdominal hysterectomy. The goal of anesthetic management is to prevent the known triggers of myotonic crisis, such as hypothermia, shivering, and hyperkalemia; and to avoid depolarizing muscle relaxants and anticholinesterase agents.
  
  
  METHODS
  In this patient, the authors used combined spinal and epidural block for intraoperative anesthesia and postoperative analgesia.
  
  
  RESULTS
  The advantages of the combined technique offers rapid onset and good muscle relaxation from subarachnoid block, with the ability to supplement analgesia through the epidural catheter both during and after surgery. In addition, the potential complications associated with general anesthesia, including respiratory insufficiency, aspiration pneumonia, cardiac arrhythmia, and heart failure can be avoided. The other measures were directed toward the prevention of shivering, a common problem encountered with general or regional anesthesia.
  
  
  CONCLUSIONS
  After the postoperation, optimal analgesia was obtained by infusing local anesthetic (0.125% bupivacaine) via the epidural catheter. No obvious side effects occurred. The authors believe combined spinal and epidural block provides a safe alternative, to other techniques, and minimizes the potential hazards of myotonic dystrophy, while offering effective intraoperative anesthesia and postoperative analgesia.
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, Taipei, Republic of China.
authors.forename: Y G
authors.initials: YG
authors.lastname: Cherng
authors.forename: Y P
authors.initials: YP
authors.lastname: Wang
authors.forename: C C
authors.initials: CC
authors.lastname: Liu
authors.forename: J J
authors.initials: JJ
authors.lastname: Shi
authors.forename: S C
authors.initials: SC
authors.lastname: Huang
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D005260:Female; D006801:Humans; D007044:Hysterectomy; D009223:Myotonic Dystrophy