Anesthetic Management Using Epidural Anesthesia and Continuous Intravenous Remifentanil in a Cesarean Section With Tethered Cord Syndrome: A Case Report

Spinal anesthesia is contraindicated in parturients with tethered cord syndrome undergoing cesarean sections. The epidural approach is an attractive anesthetic alternative. However, sacral complications can compromise their efficacy. A 33-year-old parturient with a history of spina bifida and tethered cord syndrome was admitted for a cesarean section. Since imaging studies showed no abnormalities in the epidural space at the lumbar level, the anesthesiologist proposed epidural anesthesia. Continuous intravenous remifentanil provided additional analgesia. During uterine incision closure, the parturient complained of deep visceral pain. Consequently, the intravenous remifentanil dose was increased. The perioperative course for the parturient and neonate was uneventful. For our parturient with tethered cord syndrome, the combination of epidural anesthesia and continuous intravenous remifentanil provided stable anesthesia during the cesarean section without apparent adverse effects to the parturient and neonate.