Epidural analgesia in a parturient with classic type Ehlers-Danlos syndrome

Difficult intubation during rapid sequence induction in a parturient with Ehlers-Danlos syndrome, hypermobility type

“…24 Of interest, local anaesthetic agent failure has also been reported in a parturient with EDS-classic type. 25 By contrast, the successful use of a neuraxial technique in a parturient with EDS-HT has been reported 21 and, as noted above, local anaesthetic agents should work in most patients.…”

“…Patients with EDS-HT may have an unstable cervical spine and temporomandibular joint dysfunction. [22][23][24][25][26][27][28] A thorough history should be taken and the cervical spine and corresponding nerve roots examined, including radiologic investigations if necessary. Cervical spine movement should be minimised during positioning and intubation, and awake fibreoptic intubation should be considered in cases of significant cervical spine instability.…”

“…Temporomandibular joint dysfunction due to hypermobility is most commonly associated with restricted mouth opening due to pain, which can be relieved, and therefore overcome, by the induction of general anaesthesia. [22][23][24][25][26][27][28] During airway manipulation, the mouth should not be opened further than necessary and the jaw manoeuvered firmly but not forcefully. 29 In our patient, the intubation difficulty probably arose from collapse of fibro-elastic tissues and adjoining C-shaped cartilages of the trachea with application of cricoid pressure.…”

Anaesthesia for caesarean section in a patient with Ehlers-Danlos syndrome associated with postural orthostatic tachycardia syndrome

“…There are reports of poor effect of local anaesthesia in Ehlers-Danlos syndrome. 23 It was felt that a single-shot spinal could be more reliable and would avoid use of another larger needle. As the epidural dose had not produced block beyond the lumbar dermatomes, and little volume effect was expected to remain at this time, it was felt that a 'normal' spinal dose could be given with little risk of high block.…”

Awake intubation using an intubating laryngeal mask airway in a parturient with spina bifida

“…We numbed the airway thoroughly, both above and below the vocal cords with EMLA because it provides better oral analgesia than 2% or 5% lidocaine gel. 8,9 In future cases, we might use an intravenous opioid with a faster onset and shorter action than butorphanol to achieve an even faster overall procedure.…”