[Anesthetic management of obstetrical labor in a parturient with muscular carnitine palmitoyl transferase deficiency].
We report a case of a patient with carnitine palmityl deficiency in active labour. We discuss the metabolic and energetic implications of obstetrical labour in regard with the mitochondrial myopathy and we propose an optimal management. Neuroaxial analgesia and glucose infusion are indicated in early labour because it is necessary to alleviate stress and pain in order to avoid rhabdomyolysis associated with CPT deficiency. Combined spinal epidural analgesia using intrathecal opioid alone then epidural naropein should be a relevant choice because of a minimal motor blockage. Monitoring of myolysis using serum creatinine phosphokinase levels must take in account CK and MB fractions releases to the circulation during obstetrical labour.
Moundras
J M
JM
Service d'anesthésie-réanimation, clinique universitaire P. Gellé, Roubaix, France.
Wattrisse
G
G
Leroy
B
B
Decocq
J
J
Krivosic-Horber
R
R
D000328:Adult; D000577:Amides / Q000627:therapeutic use; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000773:Anesthesia, Obstetrical; D000779:Anesthetics, Local / Q000627:therapeutic use; D002334:Carnitine O-Palmitoyltransferase / Q000172:deficiency*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D007743:Labor, Obstetric; D017240:Mitochondrial Myopathies / Q000201:enzymology; D018482:Muscle, Skeletal / Q000201:enzymology; D011247:Pregnancy; D012206:Rhabdomyolysis / Q000517:prevention & control; D000077212:Ropivacaine
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D007527:Isoenzymes; D000077212:Ropivacaine; D002334:Carnitine O-Palmitoyltransferase; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D005947:Glucose