Ultrasonography Guided Spinal Anesthesia In A Case With Severe Kyphoscoliosis

Öz

ABSTRACT

Patients with spinal abnormalities present unusual challenges for the administration of sedation and anesthesia during surgical and technical procedures. Airway management and respiratory problems are the commonest. In this case with severe kyphoscoliosis, we aimed to evaluate the advantages of spinal anesthesia technique performed under the guidance of ultrasonography. A 80-year-old female patient presented to our hospital with total uterine prolapsus. Medical history of the patient revealed severe congenital kyphoscoliosis, and restrictive lung disease. Lumbar vertebras and intervertebral spaces of the patient were scanned with an 8MHz head piece of the ultrasound. For spinal access, L4-L5 intervertebral space through which dura can be observed was selected. At the end of the operation, pin prick test detected sensory block at T12 dermatome. This case demonstrates that spinal anesthesia performed under the guidance of ultrasonography can be successful even in cases of severe kyphoscoliosis.

Key words: Anesthesia, Spinal, Neuroaxial blockade, Kyphoscoliosis, Ultrasonography

Kaynakça

1. Watson MJ, Evans S, Thorp JM. Could ultrasonography be used by an anaesthetist to identify a specified lumbar interspace before spinal anaesthesia? British journal of anaesthesia. 2003;90(4):509-11.
2. Suzuki S, Yamamuro T, Shikata J, Shimizu K, Iida H. Ultrasound measurement of vertebral rotation in idi-opathic scoliosis. The Journal of bone and joint sur-gery British volume. 1989;71(2):252-5.
3. Hong CM, Galvagno SM. Patients with Chronic Pulmo-nary Disease. Med Clin N Am. 2013;97(6):1095.
4. Payo J, Perez-Grueso FS, Fernandez-Baillo N, Garcia A. Severe restrictive lung disease and vertebral surgery in a pediatric population. European spine journal: of-ficial publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2009;18(12):1905-10.
5. McPhail GL, Howells SA, Boesch RP, Wood RE, Ednick M, Chini BA, et al. Obstructive lung disease is common in children with syndromic and congenital scoliosis: a preliminary study. Journal of pediatric orthopedics. 2013;33(8):781-5.
6. Moran DH, Johnson MD. Continuous spinal anesthesia with combined hyperbaric and isobaric bupivacaine in a patient with scoliosis. Anesthesia and analgesia. 1990;70(4):445-7.
7. Douglas MJ. Unusual regional block. Canadian journal of anaesthesia = Journal canadien d'anesthesie. 1995;42(4):362-3.
8. Nash CL, Jr., Moe JH. A study of vertebral rotation. The Journal of bone and joint surgery American vo-lume. 1969;51(2):223-9.

9. Furness G, Reilly MP, Kuchi S. An evaluation of ultra-sound imaging for identification of lumbar interver-tebral level. Anaesthesia. 2002;57(3):277-80.
10. Chin KJ, Perlas A, Singh M, Arzola C, Prasad A, Chan V, et al. An ultrasound-assisted approach facilitates spi-nal anesthesia for total joint arthroplasty. Canadian journal of anaesthesia = Journal canadien d'anesthe-sie. 2009;56(9):643-50.
11. Weed JT, Taenzer AH, Finkel KJ, Sites BD. Evaluation of pre-procedure ultrasound examination as a screening tool for difficult spinal anaesthesia*. Anaesthesia. 2011;66(10):925-30.
12. Grau T, Leipold RW, Conradi R, Martin E, Motsch J. Efficacy of ultrasound imaging in obstetric epidural anesthesia. Journal of clinical anesthesia. 2002;14(3):169-75.