Cesarean delivery under ultrasound-guided spinal anesthesia [corrected] in a parturient with poliomyelitis and Harrington instrumentation.
OBJECTIVE
To describe the anesthetic implications, and management of a medically complex parturient, who presented for Cesarean delivery (CD). The patient had poliomyelitis complicated with severe kyphoscoliosis, which had been treated with extensive spinal surgery. We used ultrasound guidance to facilitate successful spinal analgesia and anesthesia.


METHODS
A 27-yr-old woman, with a history of poliomyelitis and moderate restrictive lung disease secondary to kyphoscoliosis, presented at 38 weeks gestation for elective CD because of cephalopelvic disproportion. The woman had Harrington rods in situ from the level of the second thoracic vertebra, to the level of the fourth lumbar vertebra. Ultrasound guidance enabled one intervertebral space to be visualized (L5-S1), 3 cm from the expected spinal midline, and spinal anesthesia was performed at this interspace without any complications. A healthy infant was delivered, and the mother recovered uneventfully.


CONCLUSIONS
Spinal anesthesia can be effectively performed in patients with poliomyelitis and severe kyphoscoliosis, that has been treated with extensive Harrington instrumentation. To facilitate regional techniques in such patients, bedside ultrasound may be greatly beneficial in identifying the correct spinal interspace.
Costello
Joseph F
JF
Department of Anesthesia and Pain Management, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G1X5, Canada. joeycos@eircom.net
Balki
Mrinalini
M
D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D001858:Bone Nails; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008171:Lung Diseases / Q000209:etiology; D009339:Needles; D011051:Poliomyelitis / Q000150:complications* / Q000000981:diagnostic imaging; D011247:Pregnancy; D012129:Respiratory Function Tests; D012600:Scoliosis / Q000150:complications* / Q000000981:diagnostic imaging; D013131:Spine / Q000000981:diagnostic imaging*; D014463:Ultrasonography