Anesthetic management of maternal with rare Myositis ossificans disease undergoing emergency surgery for postpartum hemorrhage

Abstract

Myositis ossificans (MO) is a rare disease which involve calcification of the pterygoid muscles leading to severe trismus and limited mouth opening, that is considered as difficult airway when proceeding with general anesthesia (GA). We report a case of 26-year-old parturient with an underlying MO of the pterygoid muscles, who developed postpartum hemorrhage due to retained placenta, and needed emergency manual removal of the placenta in the operating room. Providing anesthesia for these patients can present a significant challenge. Difficulty arises related to combination of airway management for GA, resuscitation and a narrow time window to commence to the surgery. Awake fiberoptic intubation is a safe method to secure the airway for such patient while multidisciplinary team effort of focused planning and resuscitation is crucial to avoid maternal morbidity and airway catastrophe.

Abbreviations: MO - Myositis Ossificans; GA - General Anesthesia; PPH - Postpartum Hemorrhage; TCI – Target Controlled Infusion

Key words: Airway management; Awake fiberoptic intubation; Intubation; Myositis ossificans; Parturient; Postpartum hemorrhage

Citation: Awang MA, bin Mohd Yusof MF. Anesthetic management of a parturient with myositis ossificans undergoing emergency surgery for postpartum hemorrhage. Anaesth. pain intensive care 2022;27(2):266−268; DOI: 10.35975/apic.v27i2.1977

Received: August 19, 2022; Reviewed: January 25, 2023; Accepted: January 31, 2023