Background and Aims:Continuous spinal anaesthesia (CSA) is an underutilised anaesthetic technique. Our objectives were to evaluate the use of CSA in our institution, its efficacy, ease to use and safety.Methods:This was a retrospective analysis conducted in a tertiary centre. Records of all patients who underwent surgery and received CSA between December 2008 and July 2017 were reviewed. Their demographic profiles, type and duration of surgery were analysed. The outcomes measured were the success of CSA, technical evaluation and difficulties encountered, intraoperative haemodynamics, usage of vasopressors and any reported complications. Statistical analysis was done using Chi-square test.Results:Three hundred and eighteen patients (94%) successfully underwent surgery using CSA. Twenty cases (6%) had failed CSA, of which five of them had CSA insertion failure, while the rest failed to complete the operation under CSA, thus requiring conversion to general anaesthesia. Patients who have had an initial intrathecal local anaesthetic (LA) volume ≥1.5 ml had higher odds (odds ratio (OR) 2.78; 95% confidence interval [CI], 1.70–4.57) of developing hypotension compared to those who had <1.5 ml (P < 0.001). There were no reported post-dural puncture headache, neurological sequelae or infection.Conclusion:CSA is a useful anaesthetic technique with low failure rate. The key to achieving haemodynamic stability is by giving a small initial bolus, then titrating the block up to required height using aliquots of 0.5 ml of intrathecal LA through the catheter.
Achondroplatic patients have limited neck extension, large head, large tongue and narrowed nasal, oral, tracheal and pharyngeal airway (1). Airway oedema and large breast from term pregnancy further complicates airway management. Developmental stenosis of the cervical and lumbar canals is common in achondroplasia due to a premature fusion of the vertebrae. They can also have narrow spinal canal, reduced epidural space, kyphoscoliosis and vertebral body deformities. An MRI study by Jeong et al. found that their spinal canal interpedicular distance progressively narrows instead of widens (2).This may lead to failure of CNB and unpredictable block height. The dose of CNB has to be balanced with the risk of severe hypotension and high block. In addition, the gravid uterus in term pregnancy further increases block height. Danelli et al indicated the minimum effective dose of intrathecal bupivacaine providing effective spinal block in 95% of the women undergoing caesarean section is 0.06 mg/cm height (3). However, as surgical time could be longer than expected in our patient, CSE allows titration of block height and duration as required.
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