[The use of epidural ropivacaine for a gravida with disposition for malignant hyperthermia]

It is reported that ropivacaine, a new amide-linked local anesthetic, can be used safely in patients susceptible to malignant hyperthermia. We report a case of the use of epidural ropivacaine for a gravida with disposition for malignant hyperthermia. A 33-year-old female patient, 11 weeks and 2 days pregnant, was admitted for torsion of the right ovarian cyst. Five years before, she had been prepared for operation for uterine myoma. After premedication with atropine 0.5 mg and hydroxyzine 50 mg i.m. her body temperature increased to 39.0 degrees C, and the operation was postponed. By muscle biopsy she was diagnosed susceptible to malignant hyperthermia. Two months thereafter, the operation for uterine myoma was performed under epidural lidocaine and intravenous propofol anesthesia. Three years ago, she had cesarean section under epidural anesthesia using mepivacaine. This time, the epidural catheter was inserted at L 3-4 interspace, and 10 ml of 1.0% ropivacaine was administrated. After fifteen minutes analgesia was obtained to T 10-L 2. Forty minutes later the operation was performed and the patient was safely anesthetized by ropivacaine. Later at 37 weeks and 3 days pregnancy, cesarean section was performed with epidural ropivacaine.