OJAnes  Vol.2 No.3 , July 2012
Anesthetic Management of a Parturient with Thalidomide Phocomelia
Abstract: The teratogenicity of thalidomide has been known since the early 1960s [1]. Thalidomide is currently used world wide, including the United States, to treat erythema nodosum leprosum, multiple myeloma, refractory Crohn’s disease, aphthous stomatitis and HIV wasting syndrome. New cases of thalidomide phocomelia are being reported as well. We report a case of the anesthetic challenges of a 23 year-old parturient with thalidomide phocomelia and review the important anesthetic challenges it presents. Spontaneous vaginal delivery under continuous lumbar epidural was achieved in this challenging patient. However, it required careful planning for reliable intravenous access and the use of magnetic resonance imaging (MRI) of her pelvis and lumbar spine.
Cite this paper: S. Blacker and T. Angelo, "Anesthetic Management of a Parturient with Thalidomide Phocomelia," Open Journal of Anesthesiology, Vol. 2 No. 3, 2012, pp. 59-61. doi: 10.4236/ojanes.2012.23014.

[1]   W. G. McBride, “Thalidomide and Congenital Abnormalities (Letter),” Lancet, Vol. 1, 1962, p. 45.

[2]   P. J. Barrett and J. F. McGeachie, “Anaesthesia and Thalidomide-Related Abnormalities,” International Journal of Obstetric Anesthesia, Vol. 1, No. 4, 1992, pp. 235-236. doi:10.1016/0959-289X(92)80012-H

[3]   W. Lenz, “Thalidomide and Congenital Abnormalities (Letter),” Lancet, Vol. 2, 1961, p. 1358.

[4]   S. L. Nightingale, “From the Food and Drug Administration: Thalidomide Approved for Erythema Nodosum Leprosum,” Journal of the American Medical Association, Vol. 280, 1998, p. 872. doi:10.1001/jama.280.10.872

[5]   C. Therapontos, L. Erskine, E. R. Gardner, F. D. William, N. Vargesson, “Thalidomide Induces Limb Defects by Preventing Angiogenic Outgrowth During Early Limb Formation,” Proceedings of the National Academy of Sciences of the United States of America, Vol. 106, No. 21, 2009, pp. 8573-8578. doi:10.1073/pnas.0901505106

[6]   C. G. H. Newman, “Clinical Observations on the Thalidomide Syndrome,” Journal of the Royal Society of Medicine, Vol. 70, No. 4, 1977, pp. 225-227.

[7]   J. W. McCrory, “Anaesthesia and Thaloidomide-Related Abnormalities,” Anaesthesia, Vol. 43, No. 7, 1988, pp. 613-614. doi:10.1111/j.1365-2044.1988.tb06736.x

[8]   A. R. Williams and M. K. Bailey, “Anesthetic Management of a Patient with Tetra-Amelia,” Southern Medical Journa, Vol. 92, No. 3, 1999, pp. 325-327. doi:10.1097/00007611-199903000-00014

[9]   P. G. Maouris and P. J. Hirsch, “Pregnancy in Women with Thalidomide-induced Disabilities. Case Report and a Questionnaire Study,” British Journal of Obstetrics and Gynaecology, Vol. 95, No. 7, 1988, pp. 717-719. doi:10.1111/j.1471-0528.1988.tb06536.x

[10]   R. J. Powell. “Thalidomide: Current Uses,” BioDrugs, Vol. 11, No. 6, 1999, pp. 409-416. doi:10.2165/00063030-199911060-00005

[11]   S. K. Teo, J. L. Harden, A. B. Burke, F. H. Noormohamed, M. Youle, M. A. Johnson, B. S. Peters, D. I. Stirling and S. D. Thomas, “Thalidomide Is Distributed into Human Semen After Oral Dosing,” Drug Metabolism and Disposition, Vol. 29, No. 10. 2001, pp. 1355-1357.

[12]   L. Schuler-Fuccini, R. C. Soares, A. C. de Sousa, C. Maximino, E. Luna, I. V. Schwartz, C. Waldman and E. E. Castilla, “New Cases of Thalidomide Embryopathy in Brazil,” Birth Defects Research, Vol. 79, No. 9, 2007, pp. 671-672. doi:10.1002/bdra.20384