Case Report: Use of Ketamine in Combination with Epidural Anesthesia for Cesarean Section in the Patient with Severe Congenital Hypothyroidism

Background: Severe maternal congenital hypothyroidism with term pregnancy is extremely rare. It is really challenging to make an optimal anesthesia management strategy that is both less stressful for the anesthesiologist and safer for both the mother and her infant. Case presentation: A case is presented for a 22-year-old pregnant woman with severe congenital hypothyroidism, who was undergone successful epidural anesthesia for an elective cesarean section (CS). She was weight 28 Kg and measured 112 cm in height at term. Spontaneous ventilation was maintained throughout the case while ketamine was used for attenuating the activity of sympathetic system and alleviating the pain and anxiety of the patient. Both the parturient and neonate were well and discharged 4 days later. Conclusion: it is rare that natural conception succeeds on this severe congenital hypothyroid woman. In high-risk patients with severe congenital hypothyroidism, we recommend strongly that epidural anesthesia may be an optimal and safe technique for both the mother and her infant. Keywords: Congenital hypothyroidism, epidural anesthesia, ketamine