title: Emergency caesarean section in a patient with myotonic dystrophy: a case of failed postoperative extubation in a patient with mild disease.
abstract: A 21-year-old primiparous patient with subclinical myotonic dystrophy presented at a tertiary hospital at 38 weeks gestation in active labour, having previously been reviewed in the high-risk pregnancy clinic. A non-reassuring cardiotocogram and raised foetal scalp lactate necessitated an emergency caesarean section. On extubation following an otherwise unremarkable general anaesthetic, the patient required prompt re-intubation due to respiratory compromise, followed by a more gradual period of weaning from positive pressure ventilation. This review explores the implications of myotonic dystrophy for anaesthesia, discusses its multi-system involvement and highlights the difficulties in identifying at-risk patients in the perioperative setting.
authors.affiliation: Department of Anaesthesia, Gosford Hospital, Gosford, New South Wales, Australia.
authors.forename: P M
authors.initials: PM
authors.lastname: Owen
authors.forename: C
authors.initials: C
authors.lastname: Chu
mesh_terms: D015148:Cardiotocography; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D019344:Lactic Acid / Q000378:metabolism; D009223:Myotonic Dystrophy / Q000150:complications* / Q000503:physiopathology; D011175:Positive-Pressure Respiration / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D012535:Scalp; D055815:Young Adult
chemical_list: D019344:Lactic Acid