Very low-dose spinal anesthesia for cesarean section in a morbidly obese preeclamptic patient and its potential implications.
To our knowledge, based on a literature search, this is the first case report of successful cesarean section requiring a very low total dose of 5 mg hyperbaric spinal bupivacaine without any spinal or intravenous supplements in a morbidly obese (BMI=66 kg/m(2)) preeclamptic parturient. This parturient appeared to be more sensitive than the average to spinal anesthesia for cesarean section. Titrating the neuraxial drugs to effect with a combined spinal-epidural or epidural technique instead of a single-shot spinal may be useful in cases such as this. This report does not suggest the routine use of low-dose spinal anesthesia without supplements, but illustrates the wide variability in dosage and sensitivity to spinal anesthetics, and suggests that further research is needed in this area, particularly in morbidly obese parturients. Furthermore, it emphasizes the importance of vigilance and frequent blood pressure and respiration monitoring even in cases of low-dose spinal analgesia, such as that used in the combined spinal-epidural technique for labor analgesia.
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
M
M
Reyes
P H
PH
Pan
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D002585:Cesarean Section; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007741:Labetalol / Q000627:therapeutic use; D008278:Magnesium Sulfate / Q000627:therapeutic use; D016343:Monitoring, Intraoperative; D009767:Obesity, Morbid / Q000150:complications*; D011225:Pre-Eclampsia / Q000150:complications*; D011247:Pregnancy
D000319:Adrenergic beta-Antagonists; D000779:Anesthetics, Local; D008278:Magnesium Sulfate; D007741:Labetalol; D002045:Bupivacaine