Anaesthetic management of labour and delivery in the parturient with mitochondrial myopathy

Abstract

Purpose: We describe the anaesthetic management for Caesarean section in a parturient with a defect in complex III of the respiratory drain who had increased lactate concentrations at rest and with exercise. Clinical features: We administered effective epidural anaesthesia with lidocaine for Caesarean delivery. The serum lactate concentration was less than the preoperative value both during and after surgery. Shivering during the perioperative period was avoided by administering warm iv fluids, warm local anaesthetic solution and epidural meperidine. Pain relief after surgery was provided with iv PCA morphine augmented by local infiltration with bupivacaine to fascia and skin edges and epidural injection with meperidine. Conclusion: Mitochondrial myopathies are an uncommon group of disorders in which mitochondrial dysfunction leads to clinical disease of muscle and sometimes of other organs with high energy requirements. The management of labour and delivery in women with mitochondrial myopathies should be individualized according to severity of disease and formulated by consulation between attending physicians and the anaesthetist. Epidural analgesia reduces stress at work associated with labour and reduces oxygen demand during labour However, parturients with defects of the respiratory chain with documented increased lactate concentrations at rest and with exercise are best managed with elective Caesarean delivery with regional anaesthesia to prevent life-threatening lactic acidosis during labour. The association between malignant hyperthermia and these disorders have not been proved, but it appears prudent to consider these women as MH susceptible until definitive data regarding the possible relationship are available.