Anesthetic management of a parturient with Stiff person syndrome for urgent cesarean delivery

Successful Anesthetic Management of Patient with Stiff Person Syndrome

“…Epidural anesthesia has been used in SPS patient for urgent cesarean-section successfully. 2 In patients with SPS, there is conflicting evidence on the use of muscle relaxants. In a case report by Obara et al, the use of vecoronium in a diagnosed case of SPS for thymectomy, six week later for emergency appendectomy and one year later for endoscopic nasal sinus surgery had no adverse effect and 25% twitch recovery time was within normal limit.…”

“…The disease is more common in females than males with 2:1 ratio. 2 The diagnosis of the disease is often delayed due to its rarity and non-specific signs and symptoms. Muscle spasms associated with the disease are very debilitating and fluctuating in severity and timing.…”

“…These spasms may occur spontaneously or triggered by pain, anxiety and contact with the unusual surface or loud noises. 2 The primary pathology is the presence of autoantibodies against glutamic acid decarboxylase 65 isoenzyme (GAD 65) and positive serology is not required for the diagnosis. 3 Glutamic acid decarboxylase (GAD) is responsible for the last rate limiting step in the synthesis of gamma-aminobutyric acid (GABA).…”