Real-time ultrasound-guided spinal anesthesia in patients with a challenging spinal anatomy: two case reports.
Spinal anesthesia may be challenging in patients with poorly palpable surface landmarks or abnormal spinal anatomy. Pre-procedural ultrasound imaging of the lumbar spine can help by providing additional anatomical information, thus permitting a more accurate estimation of the appropriate needle insertion site and trajectory. However, actual needle insertion in the pre-puncture ultrasound-assisted technique remains a 'blind' procedure. We describe two patients with an abnormal spinal anatomy in whom ultrasound-assisted spinal anesthesia was unsuccessful. Successful dural puncture was subsequently achieved using a technique of real-time ultrasound-guided spinal anesthesia. This may be a useful option in patients in whom landmark-guided and ultrasound-assisted techniques have failed.
Department of Anesthesia, Toronto Western Hospital, Toronto, ON, Canada. gasgenie@yahoo.co.uk
K J
KJ
Chin
V W S
VW
Chan
R
R
Ramlogan
A
A
Perlas
D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000295:instrumentation / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D004388:Dura Mater / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D017843:Ligamentum Flavum / Q000000981:diagnostic imaging; D008159:Lumbar Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging; D008297:Male; D009339:Needles; D012600:Scoliosis / Q000000981:diagnostic imaging; D013115:Spinal Canal / Q000000981:diagnostic imaging; D013123:Spinal Fusion; D014159:Transducers; D018084:Ultrasonography, Interventional / Q000379:methods*
D000779:Anesthetics, Local; D002045:Bupivacaine