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Category: Volume 08 Issue 05 May 2020
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Title: Pregnancy with Short Stature - Challenges for Anesthesiologist to estimate dose of Hyperbaric Bupivacaine and manage Physiological Changes during cesarean section: A Case Series

Authors: Dr Vipan Garg, Dr Anju Bala, Dr Mohit Bajaj, Dr Swati Mahajan

 DOI: https://dx.doi.org/10.18535/jmscr/v8i5.10

Abstract

 

Short stature female presenting for lower segment cesarean section poses a clinical challenge to anesthesiologists. There can be 100 of causes of short stature, out of which major one is achondroplasia. There is risk for regional as well as general anesthesia in such patients like airway complications, difficulty in dose estimation of hyperbaric bupivacaine, risk of high spinal, failure of neuraxial block due to spinal deformities and spinal canal stenosis. All these risks lead to controversies in choosing type of anesthesia and dose of spinal bupivacaine. Here we present a case series of three patients who underwent cesarean sections under Spinal Anesthesia. The most important point is the careful perioperative management.

Keywords: Short stature, Hyperbaric Bupivacaine, Spinal Anesthesia.

References

  1. Şıklar Z, Berberoğlu M. Syndromic disorders with short stature. J Clin Res Pediatr Endocrinol. 2015;6:1–8.
  2. Ayoubi JM, Jouk PS, Pons JC. Diastrophic dwarfism and pregnancy. Lancet. 2001; 358:1778.
  3. Dubiel L, Scott GA, Agaram R, et al. Achondroplasia: anaesthetic challenges for caesarean section. Int J Obstet Anesth 2014;23:274–278.
  4. İnan G, Yayla E, Tas¸ Ü, et al. Single shot spinal anaesthesia for caesarean delivery of two achondroplasic parturients. Turk J Anaesthesiol Reanim 2015;43:285–287.
  5. Mitra S, Dey N, Gomber KK. Emergency cesarean section in a patient with achondroplasia: an anesthetic dilemma. J Anesth ClinPharmacol 2007;23:315–318.
  6. Palomero MA, Vargas MC, Peláez EM, et al. Spinal anaesthesia for emergency caesarean section in an achondroplastic patient. Eur J Anaesthesiol2007;24:981–982.
  7. Osorio Rudas W, SochaGarcía NI, Upegui A, et al. Anesthesia for cesarean section in a patient with achondroplasia. Rev ColombAnestesiol2012;40:309–312.
  8. DeRenzo JS, Vallejo MC, Ramanathan S. Failed regional anesthesia with reduced spinal bupivacaine dosage in a parturient with achondroplasia presenting for urgent cesarean section. Int J Obstet Anesth 2005;14:175–178.
  9. Samra T, Sharma S. Estimation of the dose of hyperbaric bupivacaine for spinal anaesthesia for emergency caesarean section in an achondroplastic dwarf. Indian J Anaesth 2010; 54:481.
  10. Danelli G, Zangrillo A, Nucera D, Giorgi E, Fanelli G, Senatore R, et al. The minimum effective dose of 0.5% hyperbaric spinal bupivacaine for cesarean section. Minerva Anestesiol. 2001;67:573–7.
  11. Ravenscroft A, Govender T, Rout C. Spinal anaesthesia for emergency caesarean section in an achondroplastic dwarf. Anaesthesia. 1998;53:1236–7.

Corresponding Author

Dr Anju Bala

MD Pediatrics, DRPGMC Kangra at Tanda (HP)