Skip to main content

Have you ever thought of spinal/epidural in Dwarf pregnant



When you go to do neuro- axial block in Dwarf pregnant remember the following  10 points:

1-Dwarf patients have higher incidence of pelvic deformities,  they have higher incidence of C/S...so prepare yourself for shift from NVD to CS

2-Many dwarf patients suffer from pulmonary compromise, so they may not tolerate supine position while awake, and they may not tolerate the fluid preloading. Fluids should be given cautiously rather than large predetermined volumes. Patient with severe pulmonary compromise should be intubated.

3-Airway is Big problem in Dwarfs. They Have difficult airway (large occiput,atlantoaxial instability) and higher incidence of aspiration(BIG uterus in small abdominal cavity).So choose elective intubation rather spinal anesthesia if  you feel that patient airway will bring troubles.

4-Vertebral column is part of musculo-skeletal deformities. They have higher incidence of spinal stenosis, and difficult spaces, and surely have higher incidence of patchy epidurals...tell the patient ,"epidural may not work" and "many attempts may take place".

5-Smaller epidural space. Which mean higher incidence of wet tap..............go slowly

6-one shot spinal for C/S is not good choice...read 7 to know why

7-There is no dosage guideline for patients with short stature and abnormal spinal anatomy. With single shot spinal fears of over dosage may lead to inadequate analgesia and intraoperative discomfort ,while over dosage may lead to high spinal or total spinal. The better option is mentioned in the next point.

8-Epiural to be placed then augmented according to the anesthesia level is the better option, with careful increment of  dosage. And always prepare yourself for GA since failed block may occur....prepare the glidoscope and fiberoptic..."difficult airway"

9-Epidural Test dose may result in High spinal if the catheter was intrathecal. Again there is no clear guidelines, decreasing the dose may lead to false negative results. Giving the regular dose in divided fashion may solve this controversy.

10-Remeber GA and Regional are hazardous. Management plan should be always individualized

NB: Special Thanks to dr Ivan Colaizzi (Magee women’s hospital UPMC),who brought this topic to my attention
.

Labels

Labels:

Comments

  1. UnknownMay 7, 2016 at 4:56 AM

    Well, this is my first visit to your blog! But I admire the precious time and effort you put into it, especially into interesting articles you share here!
    anaesthesia Machine

    ReplyDelete

Post a Comment

Popular posts from this blog

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...
5 comments
Read more

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body
Post a Comment
Read more

Epidural catheter tests...not only the test dose

Siphon test The catheter is held upright and a fluid level sought. If the catheter is then elevated, the fluid level should fall (see inset) as the fluid siphons in to the epidural space, which is usually under negative pressure compared with atmospheric. If the fluid column continues to rise, this may suggest subarachnoid placement. The siphon test can be reassuring, but is not mandatory. Aspiration  This should be considered mandatory. The Luer connector is attached to the catheter and a syringe is used to apply negative pressure. Free and continued aspiration of clear fluid can indicate subarachnoid placement of the catheter. However, if saline has been used for loss of resistance, it is not unusual for a small amount of this to be aspirated. If there is doubt, the aspirated fluid can be tested for glucose (cerebrospinal fluid will generally test positive) or mixed with thiopentone (cerebrospinal fluid forms a precipitate). If blood is freely and continuously aspirated, this sug...
Post a Comment
Read more