Anesthetic management of a parturient with type III Klippel-Feil syndrome.
Klippel-Feil syndrome is believed to occur from failure of normal segmentation of cervical somites during gestation. We present the case of a 38-year-old primiparous woman with type III Klippel-Feil syndrome for elective cesarean delivery. Our patient had a short webbed neck, short stature, limited neck flexion and extension, and thoraco-lumbar abnormalities. A multidisciplinary approach, involving obstetrics, medical subspecialties, anesthesiology, otolaryngology, and radiology, were utilized to evaluate and manage this patient. Pulmonary function testing revealed a restrictive defect, but transthoracic echocardiography was normal without pulmonary hypertension. We planned a combined spinal-epidural technique; however, only the epidural technique was obtained. Cesarean delivery was commenced with favorable maternal and fetal outcomes. Post-operative pain management was provided with intravenous morphine patient-controlled analgesia.
Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. gch2p@hotmail.com
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Hsu
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Manabat
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Huffnagle
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Huffnagle
D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D004452:Echocardiography; D005260:Female; D006801:Humans; D007714:Klippel-Feil Syndrome / Q000150:complications*; D009020:Morphine / Q000627:therapeutic use; D009333:Neck / Q000002:abnormalities; D010149:Postoperative Pain / Q000188:drug therapy; D010348:Patient Care Team; D011247:Pregnancy; D012129:Respiratory Function Tests; D013131:Spine / Q000002:abnormalities
D000701:Analgesics, Opioid; D009020:Morphine