title: Anesthetic management for Cesarean delivery in parturients with a diagnosis of dwarfism.
abstract: OBJECTIVE
  The literature on the anesthetic management of parturients with dwarfism is sparse and limited to isolated case reports. Pregnancy complications associated with dwarfism include an increased risk of respiratory compromise, an increased risk of Cesarean delivery, and an unpredictable degree of anesthesia with neuraxial techniques. Therefore, we conducted this retrospective review to evaluate the anesthetic management of parturients with a diagnosis of dwarfism.
  
  
  METHODS
  We used a query of billing data to identify short statured women who underwent a Cesarean delivery during May 1, 2008 to May 1, 2013. We then hand searched the electronic medical record for qualifying patients with heights < 148 cm and a diagnosis of dwarfism. The extracted data included patient demographics and obstetric and anesthetic information.
  
  
  RESULTS
  We identified 13 women with dwarfism who had 15 Cesarean deliveries in total. Twelve of the women had disproportionate dwarfism, and ten of the 15 Cesarean deliveries were due to cephalopelvic disproportion. Neuraxial anesthesia was attempted in 93% of deliveries. The dose chosen for initiation of neuraxial anesthesia was lower than the typical doses used in parturients of normal stature. Neuraxial anesthetic complications included difficult neuraxial placement (64%), high spinal (7%), inadequate surgical level (13%), and unrecognized intrathecal catheter (7%).
  
  
  CONCLUSIONS
  The data collected suggest that females with a diagnosis of dwarfism may have difficult neuraxial placement and potentially require lower dosages of local anesthetic for both spinal and epidural anesthesia to achieve adequate surgical blockade.
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E. Huron St. F5-704, Chicago, IL, 60611, USA. elizabeth.lange@northwestern.edu.
authors.forename: Elizabeth M S
authors.initials: EM
authors.lastname: Lange
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E. Huron St. F5-704, Chicago, IL, 60611, USA.|Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Paloma
authors.initials: P
authors.lastname: Toledo
authors.affiliation: Department of Anesthesiology, University of Illinois Chicago, Chicago, IL, USA.
authors.forename: Jillian
authors.initials: J
authors.lastname: Stariha
authors.affiliation: Department of Anesthesiology, University of Illinois Chicago, Chicago, IL, USA.
authors.forename: Heather C
authors.initials: HC
authors.lastname: Nixon
mesh_terms: D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D002585:Cesarean Section / Q000379:methods*; D004392:Dwarfism / Q000601:surgery*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies