Anaesthetic Challenges Associated with Achondroplasia: A Case Report

Ekwere I.T, Edomwonyi N.P, Imarengiaye C.O

Abstract

We report the anaesthetic management of two achondroplastic patients who presented for emergency cesarean section. Regional anaesthesia could not be done in both cases as a result of technical difficulties and general anaesthesia was performed. Airway management was done with two different techniques following airway assessment. The perioperative periods were uneventful. We discuss the anaesthetic implications and problems associated with regional and general anaesthesia in achondroplastic parturients. The controversies in the anesthetic management of these patients are also highlighted (Afr. J. Reprod. Health 2010; 14[2]: 149-155).

 

 

RĖSUMĖ

 

Les Défis anesthésiques liés à l’achondroplasie: Une Observation Nous présentons un rapport sur le traitement des deux patientes qui sont venues pour l’opération césarienne d’urgence. Il n’était pas possible de faire une anesthésie régionale pour les deux cas à cause des difficultés techniques; alors nous avons fait une anesthésie générale. Le traitement du conduit aérien a été réalisé à travers deux techniques différentes suite à une évaluation du conduit aérien. Les périodes périopératoires étaient sans incidents. Nous avons discuté les implications et les problèmes liés à l’anesthésie régionale et générale chez les parturientes. Nous avons également attiré l’attention sur les controverses à l’égard du traitement anesthétique de ces patientes (Afr. J. Reprod. Health 2010; 14[2]: 149-155).

 

 

 

 

KEYWORDS: Emergency cesarean section, achondroplasia, difficult airway, subarachnoid block, General anesthesia.

We report the anaesthetic management of two achondroplastic patients who presented for emergency cesarean section. Regional anaesthesia could not be done in both cases as a result of technical difficulties and general anaesthesia was performed. Airway management was done with two different techniques following airway assessment. The perioperative periods were uneventful. We discuss the anaesthetic implications and problems associated with regional and general anaesthesia in achondroplastic parturients. The controversies in the anesthetic management of these patients are also highlighted (Afr. J. Reprod. Health 2010; 14[2]: 149-155).

 

 

RĖSUMĖ

 

Les Défis anesthésiques liés à l’achondroplasie: Une Observation Nous présentons un rapport sur le traitement des deux patientes qui sont venues pour l’opération césarienne d’urgence. Il n’était pas possible de faire une anesthésie régionale pour les deux cas à cause des difficultés techniques; alors nous avons fait une anesthésie générale. Le traitement du conduit aérien a été réalisé à travers deux techniques différentes suite à une évaluation du conduit aérien. Les périodes périopératoires étaient sans incidents. Nous avons discuté les implications et les problèmes liés à l’anesthésie régionale et générale chez les parturientes. Nous avons également attiré l’attention sur les controverses à l’égard du traitement anesthétique de ces patientes (Afr. J. Reprod. Health 2010; 14[2]: 149-155).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

KEYWORDS: Emergency cesarean section, achondroplasia, difficult airway, subarachnoid block, General anesthesia.

Full Text:

PDF

References

Berkowitz ID, Raja SN, Bender KS, Kopits SE. Dwarfs: Pathophysiology and anesthetic implications. Anesthesiology 1990; 73: 739-59.

Oriolli IM, Castilla EE, Barbosa-Neto JG. The birth prevalence rate for the skeletal dysplasias. J. Med. Genet. 1986;23: 328.

Brimacombe J R, Caunt J A. Anaesthesia in a gravid achondroplastic dwarf. Anaesthesia 1990; 45:132– 134.

Cohen S E. Anesthesia for cesarean section in achondroplastic dwarfs. Anesthesiology 1980; 52: 264–266.

Morrow M J, Black I H. Epidural anaesthesia for caesarean section in an achondroplastic dwarf. Brit. J. Anaesth. 1998; 81: 619–621.

Carstoniu J., Yee I., Halpern S. Epidural anaesthesia for Caesarean section in an achondroplastic dwarf. Can. J. Anaesth. 1992; 39: 7 708-11.

Mitra S., Nilanjan D., Gomber K.K. Emergency Cesarean Section in a Patient with Achondroplasia:

An Anesthetic Diliemma. J. Anesth. Clin. Pharmacol. 2007; 23(3): 315-318

Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology 1997;86:277–84.

Dresner MR, Freeman JM. Anaesthesia for cesarean section. Best Pract Res Clin Obstet Gynaecol. 2001; 15 (1): 127-43.

DeRenzo J.S., Vallejo M.C., Ramanathan S. Failed regional anesthesia with reduced spinal bupivacaine dosage in a parturient with achondroplasia presenting for urgent cesarean section. Intl. J. Obstet. Anesth. (2005) 14, 175–178

Walts LF, Finerman G, Wyatt GM. Anaesthesia for dwarfs and other patients of pathological small stature. Can. Anaesth. Soc. J. 1975; 22: 703-9.

Hall JG. Special problems of anesthesia for little people. http://www.lpo.on.ca/ANESTHESIA.HTM

Wardall G J, Frame W T. Extradural anaesthesia for caesarean section in achondroplasia. Brit. J. Anaesth. 1990; 64: 367–370.

Bianchi D W, Crombleholme T M, D’Alton M E, editors. Achondroplasia. In: Fetology: diagnosis and management of the fetal patient. New York: McGraw Hill; 2000: 665–671.

McArthur R D A. Obstetric anaesthesia in an achondroplastic dwarf at a regional hospital. Anaesth. Intensive Care 1992; 20: 376–378.

Harmer M. Difficult and failed intubation in obstetric. Int. J. Obstet. Anesth. 1997; 6: 25-31.

Mallampati SR, Gatt SP, Guginol D, Desai SP, Waraksa B, Freiberger D. A Clinical Sign to Predict Difficult Tracheal Intubation, A Prospective Study. Can. Anaesth. Soc. J.1985,32: 429-34.

Vasdev G.M., Harrison B.A., Keegan M.T., Burkle C.M. Management of the difficult and failed airway in obstetric anesthesia. J. Anesth. 2008; 22:38–48

Yeo SW, Chong JL, Thomas E. Difficult intubation: a prospective study. Singapore Med J 1992; 33:362– 364.

Rocke DA, Murray WB, Rout CC, Gouws E (1992) Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia. Anesthesiology 77:67–73

Mayhew J.F., Katz J., Miner M., Leiman B.C., Hall I.D. Anaesthesia for the achondroplastic dwarf.

Can. Anaesth. Soc. J. 1986 ;33: 2 : 216-21

Rudra A. Airway Management in Obstetrics. Indian J. Anaesth. 2005; 49 (4) : 328 - 335

Minville V, N’Guyen L, Coustet B, Fourcade O, Samii K. Difficult airway in obstetric using Ilma-

Fastrach. Anesth. Analg. 2004; 99:1873

Vaida SJ, Gaitini LA Another case of use of the ProSeal laryngeal mask airway in a difficult obstetric airway. Brit. J. Anaesth. 2004; 92:905

Keller C, Brimacombe J, Lirk P, Pühringer F. Failed obstetric tracheal intubation and postoperative respiratory support with the ProSealTM laryngeal mask airway. Anesth Analg 2004; 98: 1467–70

Priscu V, Priscu L, Soroker D. Laryngeal mask for failed intubation in emergency Caesarean section. Can. J. Anaesth. 1992; 39: 893.

Han TH, Brimacombe J, Lee EJ, Yang HS The laryngeal mask airway is effective (and probably safe) in selected healthy parturients for elective Cesarean section: a prospective study of 1067

cases. Can. J. Anaesth. 2001; 48:1117–1121

Refbacks

  • There are currently no refbacks.