Canadian Journal of Anesthesia

, 55:606

Cesarean delivery under ultrasound-guided spinal anesthesia, in a parturient with poliomyelitis and Harrington instumentation

Case Reports/Case Series

Abstract

Purpose: To describe the anesthetic implications, and management of a medically complex parturient, who presented for Cesarean delivery (CD). The patient had poliomyelitis complicated with severe kyphoscoliosis, which had been treated with extensive spinal surgery. We used ultrasound guidance to facilitate successful spinal analgesia and anesthesia.

Clinical features: A 27-yr-old woman, with a history of poliomyelitis and moderate restrictive lung disease secondary to kyphoscoliosis, presented at 38 weeks gestation for elective CD because of cephalopelvic disproportion. The woman had Harrington rodsin situ from the level of the second thoracic vertebra, to the level of the fourth lumbar vertebra. Ultrasound guidance enabled one intervertebral space to be visualized (L5-S1), 3 cm from the expected spinal midline, and spinal anesthesia was performed at this interspace without any complications. A healthy infant was delivered, and the mother recovered uneventfully.

Conclusions: Spinal anesthesia can be effectively performed in patients with poliomyelitis and severe kyphoscoliosis, that has been treated with extensive Harrington instrumentation. To facilitate regional techniques in such patients, bedside ultrasound may be greatly beneficial in identifying the correct spinal interspace.

Accouchement par césarienne sous rachianesthésthésie par échoguidage chez une parturiente souffrant de poliomyélite et ayant des tiges de Harrington

Résumé

Objectif: Décrire les implications anesthésiques et la prise en charge d’une parturiente complexe d’un point de vue médical et admise pour un accouchement par césarienne. La patiente souffrait de poliomyélite compliquée d’une cyphoscoliose sévère qui avait été traitée avec plusieurs interventions chirurgicales rachidiennes. Nous avons eu recours à l’échoguidage pour faciliter une analgésie et anesthésie rachidiennes réussies.

Éléments cliniques: Une femme de 27 ans présentant des antécédents de poliomyélite et une maladie pulmonaire restrictive modérément grave, conséquence d’une cyphoscoliose, a été admise à 38 semaines de grossesse pour un accouchement par césarienne programmé en raison de disproportion céphalopelvienne. La femme avait des tiges de Harrington in situ allant de la deuxième vertèbre thoracique à la quatrième vertèbre lombaire. L’échoguidage a permis de visualiser un espace intervertébral (L5-S1) à 3 cm de la ligne rachidienne médiane attendue et une rachianesthésie a été réalisée dans cet espace sans complications. La mère a accouché d’un nourrisson sain et a récupéré sans complications.

Conclusion: La rachianesthésie peut être réalisée avec succès chez les patients souffrant de poliomyélite et de cyphoscoliose grave dont le dos a été instrumenté de manière importante avec des tiges de Harrington. Dans le but de faciliter des techniques d’anesthésie régionale chez de tels patients, l’échoguidage au chevet peut s’avérer très utile pour déterminer l’espace intervertébral correct.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  1. 1.Department of Anesthesia and Pain ManagementMount Sinai Hospital, 600 University AvenueTorontoCanada

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