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SPINAL ANAESTHESIA IN A PATIENT WITH ACHONDROPLASIA FOR CAESAREAN SECTION USING AN OBJECTIVE METHOD OF LOCAL ANAESTHETIC DOSE CALCULATION
ESRA Academy. fusco p. Sep 9, 2016; 138228
Topic: Obstetric Population
Dr. pierfrancesco fusco
Dr. pierfrancesco fusco

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Abstract
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Background and Aims:

Anaesthetic management of patients with achondroplasia for caesarean section can be challenging. Spinal anaesthesia is usually the preferred technique in such patients. Choosing the correct dose of local anaesthetic in patients with short stature is vital to ensure optimal block height but is generally subjective. Here we present a successful management of a patient with achondroplasia undergoing caesarean section under spinal anaesthesia using an objective method of local anaesthetic dose calculation.

Methods:

A 29 year old achondroplastic primigravida presented for an elective caesarean section. Routine pre-operative assessment revealed diet controlled gestational diabetes, height: 127cm and weight: 66kg (BMI:38). After reviewing the literature, we performed spinal anaesthesia using hyperbaric bupivacaine 8mg (based upon 0.06mg dose/cm body height) and diamorphine 200mcg.

Results:

Sensory block height of T3 with complete motor blockade was achieved and caesarean section was performed without any patient discomfort.

Conclusions:

Spinal anaesthesia is the technique of choice for caesarean section. Determining the local anaesthetic dose in short statured patients to ensure optimal block height is usually based on experience. We were unaware of any objective method of hyperbaric bupivacaine dose calculation for spinal anaesthesia in patients with short stature undergoing caesarean section. Based upon a prospective blind study which determined the ED95 for hyperbaric bupivacaine for patients undergoing caesarean sections to be 0.06mg/cm, we decided on a dose of 8mg in our patient. The successful outcome in our case prompts us to recommend this guidance to objectively determine optimal dose of hyperbaric bupivacaine for spinal anaesthesia in achondroplastic patients undergoing caesarean section.

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