Neuraxial anaesthesia in a patient with Charcot-Marie-Tooth disease for Caesarean delivery: a case report

Abstract

Charcot-Marie-Tooth (CMT) disease is a hereditary peripheral neuropathy characterised by slowly progressive, distal-to-proximal muscle weakness. The anaesthetic concerns are the associated respiratory and diaphragmatic muscle weakness, phrenic nerve palsy, and increased sensitivity to anaesthetic agents. Our case report described a patient with underlying CMT disease who had undergone elective Caesarean delivery (CD) under combined spinal-epidural (CSE) anaesthesia. She had underlying bronchial asthma with recent exacerbation secondary to pneumonia at 25 weeks’ gestation. Her lung function test showed a moderately restrictive pattern. We decided to perform CSE using an intrathecal dose of heavy bupivacaine 8.5 mg and fentanyl 15 mcg under pre-procedural ultrasound guidance. The surgery was uneventful, and postoperative analgesia was maintained with an epidural infusion of ropivacaine 0.1% combined with fentanyl 2 mcg/mL running at 5 mL/hour. The patient’s neurological status returned to baseline on postoperative day one. Our case showed the successful use of CSE for elective CD in the patient with CMT disease without worsening neurological symptoms. With a thorough preoperative assessment of neurological status, utilisation of ultrasound guidance and minimum effective local anaesthetic dosage, neuraxial anaesthesia can be safely performed in patients with CMT disease.