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Combined Spinal and Epidural Analgesia in a Parturient With Severe Myasthenia Gravis
  1. Robert D'Angelo, M.D. and
  2. J. C. Gerancher, M.D.
  1. From the Department of Anesthesiology, Section on Obstetric Anesthesia, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina.
  1. Reprint requests: Robert D'Angelo, M.D., Department of Anesthesiology, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009


Background and Objectives 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 μg 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.

Conclusion Combined spinal and epidural anesthesia using intrathecal opioids initially provides labor analgesia with minimal muscle weakness in the parturient with myasthenia gravis.

  • myasthenia gravis
  • pregnancy
  • spinal anesthesia
  • epidural anesthesia.

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