Anesthesia and Pain Medicine

The Korean Society of Anesthesiologists (대한마취통증의학회)
권호 표지
DOI QR코드

DOI QR Code

Real-time ultrasound-guided spinal anesthesia for cesarean section in patient with severe kyphoscoliosis and Duchenne's muscular dystrophy - A case report -

  • Kim, Hyungtae (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Sung In (Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center)
  • Received : 2018.03.07
  • Accepted : 2018.08.11
  • Published : 2018.10.31
⟨ Previous Next ⟩

Abstract

Most elective cesarean sections are conducted under spinal anesthesia. Regional anesthesia has become the preferred technique, because general anesthesia is associated with a greater risk of maternal morbidity and mortality. In patients without absolute contraindication, spinal anesthesia is avoided, when procedural difficulty is increased by severe spinal deformity. A 41-year-old female patient was 33 weeks into pregnancy. Her height and weight were 145 cm and 45 kg. The patient was planned for emergency cesarean section, due to cephalopelvic disproportion. Spinal anesthesia was planned since she was suffering from Duchenne's muscular dystrophy, and had risks of respiratory failure and prolonged mechanical ventilation after general anesthesia. However, the patient also had severe kyphoscoliosis, maybe due to Duchenne's muscular dystrophy. We are reporting a successful spinal anesthesia using real-time ultrasound guidance, for cesarean section in this obstetric patient with severe kyphoscoliosis.

Keywords

References

  1. Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology 1997; 86: 277-84. https://doi.org/10.1097/00000542-199702000-00002
  2. Carvalho JC. Ultrasound-facilitated epidurals and spinals in obstetrics. Anesthesiol Clin 2008; 26: 145-58. https://doi.org/10.1016/j.anclin.2007.11.007
  3. Costello JF, Balki M. Cesarean delivery under ultrasound-guided spinal anesthesia [corrected] in a parturient with poliomyelitis and Harrington instrumentation. Can J Anaesth 2008; 55: 606-11. https://doi.org/10.1007/BF03021434
  4. Prasad GA, Tumber PS, Lupu CM. Ultrasound guided spinal anesthesia. Can J Anaesth 2008; 55: 716-7. https://doi.org/10.1007/BF03017749
  5. Yamaguchi M, Honma E, Mimura M, Yamamoto H, Takahashi E, Namiki A. Identification of the lumbar intervertebral level using ultrasound imaging in a post-laminectomy patient. J Anesth 2006; 20: 231-3. https://doi.org/10.1007/s00540-006-0406-9
  6. Grau T, Leipold RW, Conradi R, Martin E. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand 2001; 45: 766-71. https://doi.org/10.1034/j.1399-6576.2001.045006766.x
  7. Hawkins JL, Gibbs CP, Orleans M, Martin-Salvaj G, Beaty B. Obstetric anesthesia work force survey, 1981 versus 1992. Anesthesiology 1997; 87: 135-43. https://doi.org/10.1097/00000542-199707000-00018
  8. Hayes J, Veyckemans F, Bissonnette B. Duchenne muscular dystrophy: an old anesthesia problem revisited. Paediatr Anaesth 2008; 18: 100-6.
  9. Perlas A. Evidence for the use of ultrasound in neuraxial blocks. Reg Anesth Pain Med 2010; 35: S43-6. https://doi.org/10.1097/AAP.0b013e3181d2462e
  10. Elgueta MF, Duong S, Finlayson RJ, Tran DQ. Ultrasonography for neuraxial blocks: a review of the evidence. Minerva Anestesiol 2017; 83: 512-23.
  11. Perlas A, Chaparro LE, Chin KJ. Lumbar neuraxial ultrasound for spinal and epidural anesthesia: a systematic review and metaanalysis. Reg Anesth Pain Med 2016; 41: 251-60. https://doi.org/10.1097/AAP.0000000000000184
  12. McLeod A, Roche A, Fennelly M. Case series: ultrasonography may assist epidural insertion in scoliosis patients. Can J Anaesth 2005; 52: 717-20. https://doi.org/10.1007/BF03016559
  13. Chin KJ, Chan VW, Ramlogan R, Perlas A. Real-time ultrasoundguided spinal anesthesia in patients with a challenging spinal anatomy: two case reports. Acta Anaesthesiol Scand 2010; 54: 252-5. https://doi.org/10.1111/j.1399-6576.2009.02112.x