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Combined Spinal and Epidural Anesthesia for Abdominal Hysterectomy in a Patient With Myotonic Dystrophy: Case Report
  1. Yih-Giun Cherng, M.D.*,
  2. Yong-Ping Wang, M.D.*,
  3. Chien-Chiang Liu, M.D.*,
  4. Je-Jang Shi, M.D.* and
  5. Su-Cheng Huang, M.D.*,
  1. *Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
  2. Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
  1. Reprint requests: Yih-Giun Cherng, Department of Anesthesiology, No. 7, Chungshan South Road, Taipei, Taiwan 10016, Republic of China.


Background and Objectives. 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.

  • anesthetic techniques
  • regional
  • epidural
  • spinal
  • myotonia atrophica

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