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Background and Aims Melkerson rosenthal syndrome (MRS) is a rare condition characterized by recurrent episodes of facial edema, facial paralysis and fissured tongue. The anaesthetic concerns include increased risk of difficult airway caused by airway edema. Therefore, avoidance of triggers of histaminic release and use of regional anaesthesia whenever possible should be conducted. Corticosteroids and antihistamine drugs may be administered when facing airway instrumentation. Only a few published case reports of anaesthetic management were found, hence, we present a case of labour analgesia in a patient with confirmed diagnosis.
Methods A primiparous 28-year-old woman at term was admitted for labour induction. She had been diagnosed with MRS nine years ago and treated with oral deflazacort for two years, leading to remission ever since. Since then, mild exacerbations were resolved with topical corticotherapy. There were no known pharmacological triggers. She denied exacerbations during pregnancy. Airway examination showed no signs of difficult airway. She requested epidural analgesia, which was placed with no complications, followed by an initial bolus of 10 mL ropivacaine 0,2% and 10 mcg of sufentanil. Analgesia was maintained with 10 mL of 0,2% ropivacaine on demand.
Results Patient remained comfortable, hemodynamically stable, without signs or symptoms of exacerbation. Vaginal delivery occurred without complications.
Conclusions This case highlights the implications of this syndrome, especially the risk of difficult airway. Epidural analgesia is possible and a good option to avoid airway interventions. A thorough and timely evaluation is essential.
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