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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Childbirth with epidural analgesia in a pregnant woman with hypokalemic periodic...
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Vol. 69. Issue 6.
Pages 360-363 (June - July 2022)
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Vol. 69. Issue 6.
Pages 360-363 (June - July 2022)
Case report
Childbirth with epidural analgesia in a pregnant woman with hypokalemic periodic paralysis
Parto con analgesia epidural en una gestante con parálisis periódica hipocaliémica
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J. Talaván Sernaa,
Corresponding author
jutaser@alumni.uv.es

Corresponding author.
, L. Belmonte Bayoa, L. Gil Melgosab, F. Murciano Garcíaa, S. Rodríguez Martínezc
a Servicio de Anestesiología y Reanimación, Hospital Obispo Polanco, Teruel, Spain
b Servicio de Ginecología y Obstetricia, Hospital Obispo Polanco, Teruel, Spain
c Servicio de Urgencias, Hospital Obispo Polanco, Teruel, Spain
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Abstract

Familial hypokalaemic periodic paralysis (FHPP) is an uncommon genetic disease characterized by muscle weakness associated with hypokalaemia. Episodes are precipitated by drugs, stress, metabolic diseases, hypothermia or infection. We report the case of a 38-year-old pregnant women with FHPP who underwent epidural analgesia for labour. Pregnant women with FHPP require multidisciplinary management involving an anaesthesiologist, a gynaecologist and a paediatrician. It is important to maintain normothermia, prevent hyperventilation, monitor electrolytes, avoid glucose infusions and medications that cause hypokalaemia, and administer potassium supplements when required. Locoregional techniques should be preferred over general anaesthesia. Early epidural analgesia reduces the risk of pain that could trigger an episode of FHPP. In the case of general anaesthesia, drugs that can cause malignant hyperthermia should be avoided, and short-acting non-depolarizing neuromuscular blockers with blockade-depth monitoring should be used.

Keywords:
Paralysis
Hypokalemia
Periodic
Regional anesthesia
Epidural
Pregnancy
Childbirth
Resumen

La parálisis hipocaliémica periódica familiar (PHPF) es una rara entidad genética que causa episodios de debilidad muscular con hipopotasemia precipitados por fármacos, estrés, alteraciones metabólicas, hipotermia o infecciones. En este artículo se describe el caso de una gestante de 38 años con PHPF en periodo activo de parto con evolución favorable con analgesia epidural. La PHPF en la gestante requiere un manejo multidisciplinar entre anestesia, ginecología y pediatría. Está indicado mantener la normotermia, prevenir la hiperventilación, monitorizar los iones en sangre, evitar las soluciones glucosadas y las medicaciones que produzcan descensos de la calcemia, aportando suplementos de potasio cuando se precise. Se prefieren las técnicas locorregionales a la anestesia general, siendo conveniente la analgesia epidural precoz en el parto para reducir el riesgo de crisis precipitadas por el dolor. En la anestesia general conviene evitar fármacos precipitantes de la hipertermia maligna y utilizar BNMND de acción corta con monitorización neuromuscular.

Palabras clave:
Parálisis
Hipocaliemia
Periódica
Anestesia regional
Epidural
Embarazo
Parto

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