Anesthetic Considerations for Cesarean Section in a Patient with Poland Syndrome: A Case Report and Literature Review

Background: Poland syndrome is a rare congenital anomaly involving unilateral pectoralis muscle hypoplasia, often accompanied by upper limbs and chest wall defects. The unilateral underdevelopment or absence of the pectoralis major muscle in this sporadic condition can pose a cosmetic, functional or psychological impact to affected patients. Anesthetic management in obstetric settings is challenging due to potential respiratory compromise and with even higher potential risks to patients with Poland syndrome. This report de-scribes a successful anesthetic management using subarachnoid anesthesia for an elective cesarean section in a patient with Poland syndrome. Case Presentation: In this case report, a 37-year-old primigravida with Poland syndrome presented at 37 weeks gestation for elective cesarean section is the subject of interest. We describe how subarachnoid anesthesia was administered for better pain management, while avoiding general anesthesia to mitigate airway complications and potential malignant hyperthermia (MH) risks. Preoperatively a routine physical examination was conducted. There was noted the presence of signs of a mild Poland syndrome represented by mild chest wall asymmetry without respiratory compromise. The results for the blood work were within normal parameters with the exception of mild anemia and thrombocytopenia. All other laboratory results were within normal parameters. Intraoperatively, in addition to the cesarean delivery, a myomectomy was performed for a 2x2 cm anterior fibroid mass. The neonate (3065 g, Apgar 8/9) was examined as healthy. Postoperative recovery of the mother was uneventful with supportive therapy for mild anemia. Conclusions: Subarachnoid anesthesia in this case proved viable, safe and effective, avoiding potential risks with general anesthesia. Individualized care and management are a necessity for patients with Poland syndrome, specifically in obstetric patients.