Total spinal anaesthesia following epidural test dose in an ankylosing spondylitic patient with anticipated difficult airway undergoing total hip replacement

Abstract

References1. Beach PS, Beach RE, Smith LR. Hyponatraemic seizures in a child treated with desmopressin to control enuresis. Clin Pediatr 1992; 31: 566-569. 2. Yaouyanc G, Jonville AP, Yaouyanc-Lapalle H et al. Seizure with hyponatremia in a child prescribed desmopressin for nocturnal enuresis. Clin Toxicol 1992; 30: 637-641. 3. Kallio J, Rautava P, Huupponen R et al. Severe hyponatremia caused by intranasal desmopressin for nocturnal enuresis. Acta Paediatr 1993; 82: 881-882. 4. Schwab M, Wenzel D, Ruder H. Hyponatraemia and cerebral convulsion due to short term DDAVP therapy for control of enuresis nocturna. Eur J Pediatr 1996; 155: 46-48. 5. Donoghue MB, Latimer ME, Pillsbury HL et al. Hyponatremic seizure in a child using desmopressin for nocturnal enuresis. Arch Pediatr Adolesc Med 1998; 152: 290-292. 6. Apakama DC, Bleetman A. Hyponatraemic convulsion secondary to desmopressin treatment for primary enuresis. J Accid Emerg Med 1999; 16: 229-230. 7. Bernstein SA, Williford SL. Intranasal desmopressinassociated hyponatremia: a case report and literature review. J Fam Pract 1997; 44: 203-208. 8. Odeh M, Oliven A. Coma and seizures due to severe hyponatremia and water intoxication in an adult with intranasal desmopressin therapy for nocturnal enuresis. J Clin Pharmacol 2001; 41: 582-584. 9. Shindel A, Tobin G, Klutke C. Hyponatremia associated with desmopressin for the treatment of nocturnal polyuria. Urology 2002; 60: 344. 10. Weatherall M. The risk of hyponatremia in older adults using desmopressin for nocturia: a systematic review and meta-analysis. Neurourol Urodyn 2004; 23: 302-305. 11. Lose G, Mattiasson A, Walter S et al. Clinical experiences with desmopressin for long-term treatment of nocturia. EDITOR:The use of regional anaesthesia in patients with a recognized difficult airway does not solve the problem of difficult airway; the difficult airway is still present. We report a case where giving regional anaesthesia in a patient with difficult airway, required emergency securing of the airway. A 58-yr-old male patient (55 kg, 160 cm, ASA II) suffering from ankylosing spondylitis for 25 yr was scheduled for total hip replacement. Airway examination revealed interincisor distance of 4 cm, normal dentition, and reduced mentosternal distance of 6 cm due to fixed flexion deformity of neck. X-ray revealed ankylosis of spinous processes showing posterior joint involvement, resorption of the anterior surfaces of the vertebral bodies and ossification of the posterior ligaments and surrounding soft tissues. Anaesthesia was planned with a combined spinal epidural (CSE), separate needle technique, with difficult intubation cart ready. Premedication consisted of diazepam 10 mg orally the previous night and oral ranitidine 150 mg with metoclopramide 10 mg 2 h before surgery. On arrival in the operating room, routine monitoring was applied and an intravenous (i.v.) line was secured. The epidural block was attempted by the para-median approach through L 3-4 space with the patient in the sitting position but the space coul...

A Systematic Review Of Neuraxial Anesthesia In Patients With Ankylosing Spondylitis

“…As a result, 17 articles with 20 cases were included (Table 1); data are displayed using a Varadajan et al [8] 57/M CABG TEA-GA/T1-2 Median No Yes Varadajan et al [8] 51/F CABG TEA-GA/T1-2 Median No Yes Chin et al [22] 40/F THR SA/L4-5 Median USG Yes Sivrikaya et al [11] 30/F C/S SA/L3-4 Median No Yes Hyderally et al [10] 55/M THR CSEA/L3-4 ? No Yes Batra et al [9] 58/M THR EA/L3-4 Paramedian No No/TSA Sng et al [12] 33/F C/S CSEA/? Paramedian No Yes Allen et al [19] 74/M AAA TEA-GA/T10-11 ?…”

“…[7] This diversity of conditions imply that patients with AS re-quire various operations, including coronary artery bypass grafting, total hip replacement, cesarean sections, surgery for fractures of vertebrae or femur, anal fistula excision, and thyroidectomy. [8][9][10][11][12][13][14][15] Therefore, patients with AS are likely to require anesthesia at some point in their lives. Because of expected difficulties in intubation and associated organ system involvement, performing general anesthesia in patients with AS is often a cause for concern.…”

Failed epidural analgesia in a parturient with advanced ankylosing spondylitis: a novel explanation

“…4 The use of single-shot spinal anesthesia in patients with AS has been reported, 5 although total spinal anesthesia has been described most likely due to stenotic intrathecal spaces. 6 Epidural catheter placement may be technically difficult due to restricted flexion of the lumbar spine and ossification of interspinous ligaments, 2 and it often leads to complete failure. 5 Epidural catheter placement may also be associated with a higher rate of complications, including spinal hematomas.…”

Ankylosing spondylitis: recent developments and anaesthetic implications

“…A recent case report described a total spinal anaesthetic following epidural test dose in an AS patient with anticipated difficult airway for a total hip replacement. Technical difficulty and multiple attempts of a combined spinal epidural were possible contributory causes [61].…”