Skip to main content
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 8/2016

12.05.2016 | Reports of Original Investigations

Anesthetic management for Cesarean delivery in parturients with a diagnosis of dwarfism

verfasst von: Elizabeth M. S. Lange, MD, Paloma Toledo, MD, MPH, Jillian Stariha, BA, Heather C. Nixon, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 8/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

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.
Literatur
1.
Zurück zum Zitat Tyson JE, Barnes AC, McKusick VA, Scott CI, Jones GS. Obstetric and gynecologic considerations of dwarfism. Am J Obstet Gynecol 1970; 108: 688-704.CrossRefPubMed Tyson JE, Barnes AC, McKusick VA, Scott CI, Jones GS. Obstetric and gynecologic considerations of dwarfism. Am J Obstet Gynecol 1970; 108: 688-704.CrossRefPubMed
2.
Zurück zum Zitat Berkowitz ID, Raja SN, Bender KS, Kopits SE. Dwarfs: pathophysiology and anesthetic implications. Anesthesiology 1990; 73: 739-59.CrossRefPubMed Berkowitz ID, Raja SN, Bender KS, Kopits SE. Dwarfs: pathophysiology and anesthetic implications. Anesthesiology 1990; 73: 739-59.CrossRefPubMed
3.
Zurück zum Zitat de Boer HD, Hemelaar A, van Dongen R, Gielen MJ. Successful epidural anaesthesia for caesarean section in a patient with spondyloepiphyseal dysplasia. Br J Anaesth 2001; 86: 133-4.CrossRefPubMed de Boer HD, Hemelaar A, van Dongen R, Gielen MJ. Successful epidural anaesthesia for caesarean section in a patient with spondyloepiphyseal dysplasia. Br J Anaesth 2001; 86: 133-4.CrossRefPubMed
4.
Zurück zum Zitat Vogel TM, Ratner EF, Thomas RC Jr, Chitkara U. Pregnancy complicated by severe osteogenesis imperfecta: a report of two cases. Anesth Analg 2002; 94: 1315-7.CrossRefPubMed Vogel TM, Ratner EF, Thomas RC Jr, Chitkara U. Pregnancy complicated by severe osteogenesis imperfecta: a report of two cases. Anesth Analg 2002; 94: 1315-7.CrossRefPubMed
5.
Zurück zum Zitat Mazzanti L, Tamburrino F, Bergamaschi R, et al. Developmental syndromes: growth hormone deficiency and treatment. Endocr Dev 2009; 14: 114-34.CrossRefPubMed Mazzanti L, Tamburrino F, Bergamaschi R, et al. Developmental syndromes: growth hormone deficiency and treatment. Endocr Dev 2009; 14: 114-34.CrossRefPubMed
6.
Zurück zum Zitat Wit JM, Oostdijk W, Losekoot M. Spectrum of insulin-like growth factor deficiency. Endocr Dev 2012; 23: 30-41.CrossRefPubMed Wit JM, Oostdijk W, Losekoot M. Spectrum of insulin-like growth factor deficiency. Endocr Dev 2012; 23: 30-41.CrossRefPubMed
7.
Zurück zum Zitat Allanson JE, Hall JG. Obstetric and gynecologic problems in women with chondrodystrophies. Obstet Gynecol 1986; 67: 74-8.PubMed Allanson JE, Hall JG. Obstetric and gynecologic problems in women with chondrodystrophies. Obstet Gynecol 1986; 67: 74-8.PubMed
8.
Zurück zum Zitat Beilin Y, Leibowitz AB. Anesthesia for an achondroplastic dwarf presenting for urgent cesarean section. Int J Obstet Anesth 1993; 2: 96-7.CrossRefPubMed Beilin Y, Leibowitz AB. Anesthesia for an achondroplastic dwarf presenting for urgent cesarean section. Int J Obstet Anesth 1993; 2: 96-7.CrossRefPubMed
9.
Zurück zum Zitat DeRenzo JS, Vallejo MC, Ramanathan S. Failed regional anesthesia with reduced spinal bupivacaine dosage in a parturient with achondroplasia presenting for urgent cesarean section. Int J Obstet Anesth 2005; 14: 175-8.CrossRefPubMed DeRenzo JS, Vallejo MC, Ramanathan S. Failed regional anesthesia with reduced spinal bupivacaine dosage in a parturient with achondroplasia presenting for urgent cesarean section. Int J Obstet Anesth 2005; 14: 175-8.CrossRefPubMed
10.
Zurück zum Zitat Palomero MA, Vargas MC, Pelaez EM, Rodriguez-Ceron A, Sanchez-Conde P, Muriel C. Spinal anaesthesia for emergency caesarean section in an achondroplastic patient. Eur J Anaesthesiol 2007; 24: 981-2.CrossRefPubMed Palomero MA, Vargas MC, Pelaez EM, Rodriguez-Ceron A, Sanchez-Conde P, Muriel C. Spinal anaesthesia for emergency caesarean section in an achondroplastic patient. Eur J Anaesthesiol 2007; 24: 981-2.CrossRefPubMed
11.
Zurück zum Zitat Cohen SE. Anesthesia for cesarean section in achondroplastic dwarfs. Anesthesiology 1980; 52: 264-6.CrossRefPubMed Cohen SE. Anesthesia for cesarean section in achondroplastic dwarfs. Anesthesiology 1980; 52: 264-6.CrossRefPubMed
12.
Zurück zum Zitat Brimacombe JR, Caunt JA. Anaesthesia in a gravid achondroplastic dwarf. Anaesthesia 1990; 45: 132-4.CrossRefPubMed Brimacombe JR, Caunt JA. Anaesthesia in a gravid achondroplastic dwarf. Anaesthesia 1990; 45: 132-4.CrossRefPubMed
13.
Zurück zum Zitat Morrow MJ, Black IH. Epidural anaesthesia for caesarean section in an achondroplastic dwarf. Br J Anaesth 1998; 81: 619-21.CrossRefPubMed Morrow MJ, Black IH. Epidural anaesthesia for caesarean section in an achondroplastic dwarf. Br J Anaesth 1998; 81: 619-21.CrossRefPubMed
14.
Zurück zum Zitat Walts LF, Finerman G, Wyatt GM. Anaesthesia for dwarfs and other patients of pathologic small stature. Can Anaesth Soc J 1975; 22: 703-9.CrossRefPubMed Walts LF, Finerman G, Wyatt GM. Anaesthesia for dwarfs and other patients of pathologic small stature. Can Anaesth Soc J 1975; 22: 703-9.CrossRefPubMed
15.
Zurück zum Zitat Porter M, Mendonca C. Anaesthesia for caesarean section in a patient with diastrophic dwarfism. Int J Obstet Anesth 2007; 16: 145-8.CrossRefPubMed Porter M, Mendonca C. Anaesthesia for caesarean section in a patient with diastrophic dwarfism. Int J Obstet Anesth 2007; 16: 145-8.CrossRefPubMed
16.
Zurück zum Zitat Crawford M, Dutton DA. Spinal anaesthesia for caesarean section in an achondroplastic dwarf. Anaesthesia 1992; 47: 1007.CrossRefPubMed Crawford M, Dutton DA. Spinal anaesthesia for caesarean section in an achondroplastic dwarf. Anaesthesia 1992; 47: 1007.CrossRefPubMed
17.
Zurück zum Zitat McGlothlen S. Anesthesia for cesarean section for achondroplastic dwarf: a case report. AANA J 2000; 68: 305-7.PubMed McGlothlen S. Anesthesia for cesarean section for achondroplastic dwarf: a case report. AANA J 2000; 68: 305-7.PubMed
18.
Zurück zum Zitat Ravenscroft A, Govender T, Rout C. Spinal anaesthesia for emergency caesarean section in an achondroplastic dwarf. Anaesthesia 1998; 53: 1236-7.CrossRefPubMed Ravenscroft A, Govender T, Rout C. Spinal anaesthesia for emergency caesarean section in an achondroplastic dwarf. Anaesthesia 1998; 53: 1236-7.CrossRefPubMed
19.
Zurück zum Zitat Ravenscroft A, Rout C. Epidural anaesthesia for caesarean section in an achondroplastic dwarf. Br J Anaesth 1999; 82: 301-3.CrossRefPubMed Ravenscroft A, Rout C. Epidural anaesthesia for caesarean section in an achondroplastic dwarf. Br J Anaesth 1999; 82: 301-3.CrossRefPubMed
20.
Zurück zum Zitat Wardall GJ, Frame WT. Extradural anaesthesia for caesarean section in achondroplasia. Br J Anaesth 1990; 64: 367-70.CrossRefPubMed Wardall GJ, Frame WT. Extradural anaesthesia for caesarean section in achondroplasia. Br J Anaesth 1990; 64: 367-70.CrossRefPubMed
22.
Zurück zum Zitat Carvalho B, Durbin M, Drover DR, Cohen SE, Ginosar Y, Riley ET. The ED50 and ED95 of intrathecal isobaric bupivacaine with opioids for cesarean delivery. Anesthesiology 2005; 103: 606-12.CrossRefPubMed Carvalho B, Durbin M, Drover DR, Cohen SE, Ginosar Y, Riley ET. The ED50 and ED95 of intrathecal isobaric bupivacaine with opioids for cesarean delivery. Anesthesiology 2005; 103: 606-12.CrossRefPubMed
23.
Zurück zum Zitat Bryson GL, Macneil R, Jeyaraj LM, Rosaeg OP. Small dose spinal bupivacaine for cesarean delivery does not reduce hypotension but accelerates motor recovery. Can J Anesth 2007; 54: 531-7.CrossRefPubMed Bryson GL, Macneil R, Jeyaraj LM, Rosaeg OP. Small dose spinal bupivacaine for cesarean delivery does not reduce hypotension but accelerates motor recovery. Can J Anesth 2007; 54: 531-7.CrossRefPubMed
24.
Zurück zum Zitat Norris MC. Height, weight, and the spread of subarachnoid hyperbaric bupivacaine in the term parturient. Anesth Analg 1988; 67: 555-8.PubMed Norris MC. Height, weight, and the spread of subarachnoid hyperbaric bupivacaine in the term parturient. Anesth Analg 1988; 67: 555-8.PubMed
25.
Zurück zum Zitat Van Hecke D, De Ville A, Van der Linden P, Faraoni D. Anaesthesia and orphan disease: a 26-year-old patient with achondroplasia. Eur J Anaesthesiol 2013; 30: 776-9.CrossRefPubMed Van Hecke D, De Ville A, Van der Linden P, Faraoni D. Anaesthesia and orphan disease: a 26-year-old patient with achondroplasia. Eur J Anaesthesiol 2013; 30: 776-9.CrossRefPubMed
26.
Zurück zum Zitat Mather JS. Impossible direct laryngoscopy in achondroplasia. A case report. Anaesthesia 1966; 21: 244-8.CrossRefPubMed Mather JS. Impossible direct laryngoscopy in achondroplasia. A case report. Anaesthesia 1966; 21: 244-8.CrossRefPubMed
27.
Zurück zum Zitat Mayhew JF, Katz J, Miner M, Leiman BC, Hall ID. Anaesthesia for the achondroplastic dwarf. Can Anaesth Soc J 1986; 33: 216-21.CrossRefPubMed Mayhew JF, Katz J, Miner M, Leiman BC, Hall ID. Anaesthesia for the achondroplastic dwarf. Can Anaesth Soc J 1986; 33: 216-21.CrossRefPubMed
28.
Zurück zum Zitat Monedero P, Garcia-Pedrajas F, Coca I, Fernandez-Liesa JI, Panadero A, de los Rios J. Is management of anesthesia in achondroplastic dwarfs really a challenge? J Clin Anesth 1997; 9: 208-12. Monedero P, Garcia-Pedrajas F, Coca I, Fernandez-Liesa JI, Panadero A, de los Rios J. Is management of anesthesia in achondroplastic dwarfs really a challenge? J Clin Anesth 1997; 9: 208-12.
29.
Zurück zum Zitat Bauchat JR, McCarthy RJ, Koski TR, Wong CA. Labor analgesia consumption and time to neuraxial catheter placement in women with a history of surgical correction for scoliosis: a case-matched study. Anesth Analg 2015; 121: 981-7.CrossRefPubMed Bauchat JR, McCarthy RJ, Koski TR, Wong CA. Labor analgesia consumption and time to neuraxial catheter placement in women with a history of surgical correction for scoliosis: a case-matched study. Anesth Analg 2015; 121: 981-7.CrossRefPubMed
Metadaten
Titel
Anesthetic management for Cesarean delivery in parturients with a diagnosis of dwarfism
verfasst von
Elizabeth M. S. Lange, MD
Paloma Toledo, MD, MPH
Jillian Stariha, BA
Heather C. Nixon, MD
Publikationsdatum
12.05.2016
Verlag
Springer US
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 8/2016
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-016-0671-5

Weitere Artikel der Ausgabe 8/2016

Canadian Journal of Anesthesia/Journal canadien d'anesthésie 8/2016 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.