Background
Elephantiasis may occur due to parasites or to exposure to soil , rich in iron, aluminum, clay, potassium or other metals(podoconiasis). It is a tropical disease , very rare in Greece. The aim of this case report is the anaesthetic management of a parturient with elephantiasis.
Case Report
A 34 years old primigravida parturient is scheduled for elective cesarian section at 38th week of gestation. The elephantiasis appeared at the age of 7. After an ankle injury, an inflammation fired the appearance of the oedema. Initially, the oedema concerned only the right leg but the last year it appeared to the left leg, as well. Her condition began to deteriorate when she became pregnant. She gained 50 kilograms (her weight was 135kgr)most of them were due to the extensive leg oedema, which rendered her incapable even for walking. She presented diabetes and hypothyreodism during her pregnancy. She was under thyroxine and she was euthyrodic. Her airway seemed manageable (Mallampati I-II). The cesarean section performed under general anaesthesia keeping low the airway pressure (up to 20mmHg) and PEEP 5mmHg. After injection of ranitide and metoclopramide, propofol 200mg and succinylcholine 100mg were given for intubation. Anaesthesia was maintained with O2/N2O ( 50%/50%)  and sevoflurane 1%.After the delivery of the baby, she received morphine 5 mg for analgesia, atracurium 50 mgr, paracetamol 1gr and ondansetron 4 mgr. The neonate's APGAR score was 7, 7, 10 at 1st, 5th, and 10th min. respectively, after delivery. She recovered well, without complications.
Discussion
The targets in this case were:1) to avoid worsening the oedema 2) not to impair the lymphatic contractile activity. Performing regional anaesthesia, we were aware of vasodilation and fluid overloading for treating possible hypotension. On the other hand, local aneasthetics have shown a decrease in lymphatic function1,2.  General anaesthesia with low PEEP  and low intrathoracic pressure do not affect oedema and  lymph flow3.



06 / A rare case of a 34 years old parturient with elephantiasis