Parturient with kyphoscoliosis (operated) for cesarean section

Veliath, David George; Sharma, Raji; Ranjan, RV; Kumar, Cp Rajesh; Ramachandran, T R

doi:10.4103/0970-9185.92463

Cited by 16 publications

(12 citation statements)

References 7 publications

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“…The placement of regional epidural anaesthesia in patients with correction of a spinal deformity for scoliosis with Luque rods is a formidable task as, after spinal fixation, the screws from the spinal implant can pass through the ligamentum flavum and the scarring from the applied bone graft can distort the anatomy and prevent the location of the epidural space 106. Spinal anaesthesia is the preferred choice in these patients as the intrathecal space is not directly affected by the previous spinal surgery and the spread of local anaesthetic is more reliable than by the epidural route 107. Overall, the evidence suggests that women with kyphoscoliosis can be safely counselled and reassured of an uneventful pregnancy.…”

Section: Pre-existing Orthopaedic Complications In Pregnancymentioning

confidence: 99%

Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management

Bhardwaj

Nagandla

2014

Postgraduate Medical Journal

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Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests. Management of low back pain in pregnancy is conservative, with physical exercise for lumbar pain and minimising activities that exacerbate pain, analgesics and bed rest for pelvic girdle pain, as well as avoiding abduction beyond the pain-free zone in labour. There is evidence that stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture, transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to recognise these complications can result in long-term morbidity. Knowledge of the preoperative diagnostic investigations, surgical approaches and intraoperative positioning of the mother to avoid gravid uterus compression is vital in orthopaedic emergencies such as lumbar disc herniation, cauda equina syndrome, fractures and acute compartment syndrome of the lower limb to ensure a safe maternal and fetal outcome and to prevent serious disability. Pregnancy is not contraindicated in women with pre-existing orthopaedic complications such as kyphoscoliosis and total hip arthroplasty as there is no evidence to suggest increased maternal or fetal risks.

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Section: Pre-existing Orthopaedic Complications In Pregnancymentioning

confidence: 99%

Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management

Bhardwaj

Nagandla

2014

Postgraduate Medical Journal

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“…[7,8] Neuraxial anesthesia in this type of patient is technically challenging to the anesthesiologist. Due to angulation and rotation of vertebral body epidural space is deviated toward the convexity of angulation.…”

Section: Discussionmentioning

confidence: 99%

Repeat spinal anesthesia after a failed spinal block in a pregnant patient with kyphoscoliosis for elective cesarean section

Kumar

Singh

Prasad

et al. 2014

J Obstet Anaesth Crit Care

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view of cephalopelvic disproportion in labor. She had history of progressive spinal deformity since childhood and lower segment caesarean section done under spinal anesthesia 3 years back which was uneventful. On hospital admission, she had no complaints other than dyspnea on exertion (New York Heart Association functional class II) since 1 year. Preanesthetic examination of the airway revealed Mallampatti grade l, adequate mouth opening and neck movement. On local examination of the lumbar spine, interspinous space was not well felt. X-ray whole spine showed Kyphoscoliosis of cervicodorsal spine with concavity toward left, Cobb angle >60° and magnetic resonance imaging of the spine showed the scoliotic curvature of the cervical and thoracic vertebra with anterior ostephyte at D4 to D6 vertebra. No other intramedullary and vertebral anomalies were seen. Hemogram, renal function, and liver function tests were within normal limits. Pulmonary function test showed severe restrictive lung disease with a forced vital capacity (FVC) of 41%, forced expiratory volume in 1 s (FEV 1 ) of 35% and FEV 1 /FVC ratio of 90%. Echocardiography showed mild mitral valve prolapse and a left ventricular ejection fraction of 63% [Table 1].In view of poor lung function a neuraxial anesthesia (single shot spinal block) was planned, and the same was explained to the patient. Half an hour before shifting to the operation room intravenous ranitidine 50 mg and metoclopramide 10 mg were given as a premedication. In the operating room, standard monitoring was instituted, and baseline parameters A B S T R A C TPregnant patients with kyphoscoliosis present a unique challenge during their anesthetic management due to the physiologic changes of pregnancy and deformity of the spine leading to pulmonary abnormalities. We present a case report of a 29-year-old second gravida with kyphoscoliosis who successfully underwent elective caesarean section under repeat spinal block after failure of first spinal anesthesia.

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“…Patients with scoliosis suffer from restrictive lung disease which decreases vital capacity, functional residual capacity, tidal volume, and increases respiratory rate. 5 Exercise tolerance tests, pulmonary function test and arterial blood gas analysis helps to determine the severity of respiratory impairment. The compliance of the lung decreases with increase in work of breathing.…”

Section: Discussionmentioning

confidence: 99%