Anesth Pain Med.  2018 Oct;13(4):405-408. 10.17085/apm.2018.13.4.405.

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

• Kim H
• Shin SI

• KMID: 2435999
• DOI: http://doi.org/10.17085/apm.2018.13.4.405

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.

Keyword

Cesarean section; Muscular dystrophy; Scoliosis; Spinal anesthesia; Ultrasonography

MeSH Terms

Adult
Anesthesia, Conduction
Anesthesia, General
Anesthesia, Spinal*
Cephalopelvic Disproportion
Cesarean Section*
Congenital Abnormalities
Emergencies
Female
Humans
Mortality
Muscular Dystrophies*
Pregnancy
Respiration, Artificial
Respiratory Insufficiency
Scoliosis
Ultrasonography

Figure

• 

  Fig. 1 Chest X-ray (A) and abdomen (B) images before pregnancy. Marked kyphoscoliosis is seen. The patient’s surface anatomy and position for real-time ultrasound-guided spinal anesthesia (C). ☆: insertion site of the needle, Square: ultrasound probe.

• 

  Fig. 2 Ultrasound image immediately real-time ultrasound-guided spinal anesthesia.

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