Anesthetic Management for Cesarean Delivery in a Pregnant Patient With Spinal Muscular Atrophy Type 2: A Case Report

Spinal muscular atrophy (SMA) Type 2 is a rare autosomal recessive neuromuscular disorder that poses considerable anesthetic challenges in pregnancy, mainly because of restrictive lung physiology, progressive muscle weakness, and spinal deformity.

We report the anesthetic management of a 20-year-old Hispanic primigravida with SMA Type 2 and severe kyphoscoliosis who presented to the hospital at 25 3/7 weeks of gestation with progressive dyspnea. As her respiratory function deteriorated, an urgent cesarean section at 29 5/7 weeks of gestation, together with bilateral salpingectomy, was performed under general anesthesia. Awake nasal fiberoptic intubation was used for airway control, and anesthesia was maintained with an opioid-sparing, dexmedetomidine-based total intravenous anesthesia (TIVA) protocol with minimal adjuncts. Multimodal analgesia was implemented, and postoperative recovery was successful despite delayed extubation.

Dexmedetomidine-based TIVA with minimal adjuncts, combined with multimodal analgesia, was a feasible and safe anesthetic approach in this pregnant patient with SMA. Multidisciplinary planning was essential to optimize maternal and fetal outcomes.