Anestesia espinal en operación cesárea de paciente acondroplásica: reporte de caso

Abstract

Introduction: the successful use of regional anesthesia in achondroplasic pregnant women with a high-risk pregnancy during cesarean section, although it has been described, is infrequent since most anesthesiologists prefer the use of general anesthesia due to the difficulties in accessing the spinal canal. Case presentation: a 20-year-old woman, achondroplasic, with a gestation of 38.6 weeks and a diagnosis of polyhydramnios, who was found to have a difficult airway in the pre-anesthetic consultation due to the presence of flattening of the nasal bridge, short neck, Mallampati classification (III) and distance between incisors: <3 cm; In addition, signs of lumbar stenosis and a Body Mass Index of 51 Kg/m2 were found, which evidenced the presence of obesity. Given the risk represented by both the airway approach and the use of regional anesthesia, it was decided to use the second option, which was achieved in a single attempt; To achieve the desired anesthetic level, 0.2 mg of Morphine was administered followed by 5 mg of hyperbaric Bupivacaine, both intrathecally. The anesthetic procedure carried out was successful for both the mother and the fetus. Conclusions: this case is a sample of the success in the use of regional anesthesia in the cesarean section in an achondroplasic patient, reinforcing the opportuneness of special anesthesiological interventions in patients with rare diseases to carry out an exhaustive review of the published literature, individualize care and choose the experienced professional to perform the selected treatment.

Keywords: achondroplasia; conduction anesthesia; high-risk pregnancy; cesarean section.