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

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 rods in 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.

Locating the epidural space in obstetric patients—ultrasound a useful tool: Continuing Professional Development

“…A high frequency (7)(8)(9)(10)(11)(12)(13)(14)(15) MHz) linear transducer is preferred for peripheral nerve blocks and central venous cannulations where the structures to be visualized are located superficially. This transducer produces a high-resolution image; however, it has poor beam penetration.…”

“…However, with ultrasonography, it is now possible to perform a regional technique by identifying the interspace with preserved anatomy. 10 …”

“…Cependant, avec l'ultrasonographie, il est maintenant possible d'exécuter une technique régionale en identifiant l'espace intervertébral qui a une anatomie préservée. 10 Efficacité des techniques échoguidées L'une des principales indications pour l'utilisation de l'échographie rachidienne est l'identification des niveaux intervertébraux de la colonne lombaire. Il est important d'identifier ces niveaux de façon précise et de choisir un niveau au-dessous du cône médullaire pendant la rachianesthésie.…”

The use of ultrasound to facilitate spinal anesthesia in a patient with previous lumbar laminectomy and fusion: A case report

“…First, the intervertebral level may be accurately identified on the parasagittal scan, even in the absence of the usual bony landmarks. 2,5,15 Insertion of the needle above what is perceived to be L2/3 has been associated with injury to the conus medullaris. 16 Although the sonoanatomy appeared normal above L2/3 in our patient, we avoided needle insertion above the L3/4 interspace for this reason.…”

Ultrasound-Guided Central Neuraxial Blocks

“…There are very limited data in the anesthesia or pain medicine literature on the use of US for spinal (intrathecal) injections 42,43 although it has been shown to be useful for lumbar punctures by radiologists 44 and emergency physicians. 32 Majority of the data are in the form of case reports.…”