Anesthetic management for cesarean section and tubal ligation in a patient with Marfan syndrome, multiple sclerosis, and multiple postdural puncture headaches

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.