Anaesthetic Management of Parturient with Motor Neuron Disease for Caesarean Delivery: Case Report

Motor neuron disease (MND) is a progressive neurodegenerative disease of unknown aetiology, which results in weakness of muscles of phonation, ambulation, deglutition and respiration. It has low prevalence but high disability and fatality. Death often follows respiratory failure. There is no known cure. It is extremely rare in pregnancy, but when it occurs, the respiratory compromise worsens and anaesthesia becomes challenging. There is no consensus yet on the choice of anaesthesia. We present a 29-year-old, 32-week parturient with MND who presented with severe dyspnea, orthopnea and was diagnosed with severe respiratory distress. She was admitted into ICU and given anticoagulant and steroid therapy. Sequential mini-dose combined spinal-epidural anaesthesia (CSE) was given and surgery performed in the semi-sitting position successfully. There was no deterioration of symptoms post anaesthesia. We conclude that CSE is adequate to manage parturient with MND who has severe orthopnea following respiratory muscle paresis.