title: Combined spinal and epidural analgesia in a parturient with severe myasthenia gravis.
abstract: OBJECTIVE
  A 27-year-old woman with a history of myasthenia gravis presented for vaginal delivery.
  
  
  METHODS
  A combined spinal epidural was initiated with 7.5 microg intrathecal sufentanil at the time of first request for analgesia followed by 140 mg epidural lidocaine prior to spontaneous vaginal delivery.
  
  
  RESULTS
  The patient had a pain-free spontaneous vaginal delivery uncomplicated by muscle weakness.
  
  
  CONCLUSIONS
  Combined spinal and epidural anesthesia using intrathecal opioids initially provides labor analgesia with minimal muscle weakness in the parturient with myasthenia gravis.
authors.affiliation: Department of Anesthesiology, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1009, USA.
authors.forename: R
authors.initials: R
authors.lastname: D'Angelo
authors.forename: J C
authors.initials: JC
authors.lastname: Gerancher
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007743:Labor, Obstetric; D009157:Myasthenia Gravis; D011247:Pregnancy; D011248:Pregnancy Complications