title: Management of labor analgesia in a patient with acute myeloid leukemia.
abstract: The anesthetic implications of acute leukemia in pregnancy have not been reported. We describe the anesthetic management of a laboring primigravida at 34 weeks' gestation with new-onset acute myeloid leukemia. With multidisciplinary consultation, we recommend that neuraxial anesthesia be avoided in new-onset acute myeloid leukemia due to the risk of introducing malignant cells into the central nervous system, which can spread the disease and complicate management. We discuss the use of a fentanyl patient-controlled analgesia and dexmedetomidine as a method of labor analgesia, and the potential benefits of the latter medication in the obstetric population.
authors.affiliation: From the *Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and †Hematology-Oncology, Dana Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Kelly G
authors.initials: KG
authors.lastname: Elterman
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Meserve
authors.forename: Martha
authors.initials: M
authors.lastname: Wadleigh
authors.forename: Michaela K
authors.initials: MK
authors.lastname: Farber
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Tsen