The purpose of this review is to examine the current Libyan medical education system, look at its positive and negative aspects, and to provide suggestions and recommendations that could help improve the quality of the system today. The current Libyan medical education system has aged, and unfortunately, cannot meet both societal needs and the new requirements from the World Federation of Medical Education (WFME). The WFME issued a strong statement to all international medical schools to meet its new accreditation standards by 2023 in order for them to be recognized internationally. Lacking almost 70% of the international standards, Libyan medical schools will require considerable amount of time and resources to solve the issue. The process of changing and updating the system will involve all parts of the learning environment, including students, teachers, curriculums, resources, research, and governing bodies.

Purpose: To describe the anesthetic considerations for a nearterm parturient with progressive cauda equina syndrome who required Cesarean delivery followed immediately by decompression lumbar discectomy and laminectomy in the prone position. Clinical features:A 33-yr-old woman presented at 35 weeks gestation with severe L5-S1 disc herniation causing motor and sensory neuronal dysfunction in the lower limbs accompanied by bowel and bladder dysfunction. After urgent multidisciplinary consultations, a decision was made to proceed with general anesthesia for Cesarean delivery in the supine position with left uterine displacement, followed immediately thereafter by L5-S1 discectomy and laminectomy in the prone position. Anesthesia concerns included the risks of hemorrhage from the combined surgeries and upper airway edema from the prone position, and the physiologic changes of pregnancy. The surgeries proceeded without complication, and both mother and baby recovered uneventfully. Conclusion:With a multidisciplinary approach, two surgeries in two different positions with unique anesthetic considerations were performed safely under general anesthesia in advanced pregnancy in a parturient with cauda equina syndrome. F EW cases of cauda equina syndrome during pregnancy have been reported in the literature. [1][2][3][4][5] Most of these cases involved cauda equina syndrome in parturients early in pregnancy (before 24 weeks of gestation.). Recently, Brown and Brookfield reported performing a Cesarean delivery and laminectomy in a parturient who was eight months pregnant. 5 Our case report is the first to discuss the anesthetic management of a parturient at 35 weeks gestation who underwent a Cesarean delivery followed by laminectomy in the prone position under the same general anesthetic for cauda equina syndrome. The patient gave written consent for publication of this information. CASE REPORTS/CASE SERIES 471CAN J ANESTH 54: 6 www.cja-jca

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