We report a 29-year-old woman with
Marfan syndrome,
multiple sclerosis, and multiple
postdural puncture headaches who presented for a scheduled repeat cesarean delivery with bilateral
tubal ligation at 37 weeks gestation. During an outpatient preoperative visit, a
general anesthetic plan was ultimately selected through a shared decision-making process. The patient had an uneventful
general anesthetic that included a rapid sequence induction with direct laryngoscopy. Neonatal Apgar scores were 8 at 1 minute and 9 at 5 minutes. Prior to emergence,
fentanyl,
acetaminophen, and
ketorolac were administered intravenously and a transversus abdominus plane block was performed. On the first postoperative day, the patient expressed satisfaction with the
anesthetic plan and, in particular, the avoidance of a neuraxial technique and
postdural puncture headache. The patient was discharged on the second postoperative day with no apparent sequelae. A neuraxial
anesthetic technique is usually preferred in patients undergoing cesarean delivery, and it is safe to perform this technique in patients with either
Marfan syndrome or
multiple sclerosis. We formulated an
anesthetic plan that honored our patient's autonomy and produced a good maternal and neonatal outcome.