Total intravenous anaesthesia for caesarean section in a patient with Marfan's syndrome.

The case is described of a pregnant patient with Marfan's syndrome scheduled at 39 weeks' gestation for elective caesarean section carried out for the first time by total intravenous anaesthesia (TIVA) with continuous intravenous (i.v.) infusion of propofol. The diagnosis was based on a positive family history, classic phenotype, scoliosis, arachnodactyly, high narrow palate, hyperextensible joints, ectopia lentis and mitral valve prolapse, with a secondary low mitral insufficiency. Maternal and fetal surveillance did not detect complications during the course of pregnancy. Elective caesarean section was performed at 39 weeks due to high-risk pregnancy and to avoid the risk of haemodynamic alterations that take place during labour and delivery. The patient was given general anaesthesia with continuous i.v. infusion of propofol and boluses of atracurium and fentanyl after delivery. The haemodynamics and oxygen saturation remained stable during surgery. Apgar scores were 9 at 1 and 5 min. The post-delivery course was unremarkable and post partum echocardiography showed no changes from before caesarean section. The cardiovascular problems of Marfan's syndrome, the risk of haemodynamic changes associated with pregnancy and delivery, its anaesthetic implications and the possible advantages of TIVA with continuous i.v. infusion of propofol in the anaesthetic management of caesarean section in patients with this disease are discussed.

[Amniocentesis and single choroid plexus cyst. Current status]. / Amniocentèse et kyste isolé des plexus choroïdiens. Etat actuel.

Management of a patient with a diagnosed choroid plexus cyst (CPC) is probably one of the most difficult of all prenatal diagnostic problems. Similarity between the risk of chromosomopathy due to the appearance of CPC only and the risk of fetal mortality due to amniocentesis (both being about 1/200) is such that an individual approach must be adopted in each case. The couple must be given a full explanation of all the details, which will enable them to finally decide whether a conservative attitude is appropriate or, on the contrary, if a specific diagnosis should be sought by amniocentesis.