Authors: Deckbar J et al.
Cureus 17(11): e95993, November 2025. DOI: 10.7759/cureus.95993
This case report details the anesthetic management of a 32-year-old gravida 2 para 0 woman with mosaic Turner syndrome (TS) who achieved spontaneous pregnancy and underwent labor induction at 37 weeks. TS, characterized by short stature, skeletal deformities, and frequent cardiovascular anomalies, presents unique challenges to obstetric anesthesiologists—especially in neuraxial anesthesia where distorted anatomy and abnormal drug distribution are common.
An ultrasound-guided epidural was successfully placed at the L3–L4 level after an initial failed attempt at L4–L5 due to lumbar scoliosis. Loss of resistance was achieved at 5 cm, and the catheter was inserted to 10 cm without cerebrospinal fluid or blood return. The patient experienced effective analgesia with only about one-tenth the typical dosing—an epidural infusion of 0.1% bupivacaine with fentanyl (2 mcg/mL) at 1 mL/hour compared to the standard 8–12 mL/hour. The labor and delivery were uneventful, and both mother and newborn were discharged in stable condition.
The discussion emphasizes several anesthetic considerations in TS:
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Cardiac risks such as aortic dissection and hypertension warrant minimizing sympathetic stimulation and avoiding hemodynamic surges from intubation.
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Difficult airway due to micrognathia, webbed neck, and short stature necessitates preemptive airway planning.
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Neuraxial challenges arise from scoliosis, short vertebral distance, and unpredictable spread of local anesthetic. Ultrasound assistance improves success and safety.
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Unusual neuraxial sensitivity may require drastically reduced dosing, as seen in this case.
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Alternative techniques such as combined spinal-epidural or dural puncture epidural can help confirm placement but may not resolve dosing variability.
The report underscores that while general anesthesia remains an option in emergencies, neuraxial anesthesia—when feasible—should be preferred for its cardiovascular safety and avoidance of airway manipulation.
What You Should Know:
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Turner syndrome patients pose combined airway, cardiovascular, and neuraxial challenges during obstetric anesthesia.
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Ultrasound-guided epidural placement can overcome technical barriers caused by scoliosis and short stature.
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Local anesthetic dosing may need to be significantly reduced due to altered neuraxial anatomy and drug sensitivity.
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Preoperative multidisciplinary assessment is essential, focusing on cardiac status and airway evaluation.
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Individualized, cautious titration of neuraxial anesthesia ensures both maternal and fetal safety.
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