Anaesthetic management of labour in two patients with Klippel-Feil syndrome

Singh, D.; Mills, Gary H.; Caunt, J. A.; Alderson, J.D.

doi:10.1016/s0959-289x(96)80032-x

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…We have included 136 reports, both full publications and abstracts, covering 158 cases (see also Supporting Information, Appendices S1–S6) . Case reports largely fall into two groups: those describing equipment, or a technique, for provision of general anaesthesia; or those identifying a woman who had predicted airway difficulty, who was managed with regional analgesia or anaesthesia with the aim of avoiding of general anaesthesia.…”

Section: Resultsmentioning

confidence: 99%

“…Cases where women with predicted airway problems were managed using regional analgesia for labour are shown in the Supporting Information (Appendix S5). Successful surgical conversion for operative vaginal delivery [85,87,96] and caesarean section [86,88] were noted. Unsurprisingly, patients requiring general anaesthesia were also described [27,53,65,73].…”

Section: Regional Analgesia During Labourmentioning

confidence: 99%

“…Unless contraindicated, regional analgesia was chosen to aid the management of labour when this was planned. The ability to extend an epidural blockade for operative delivery was usually mentioned, although a back up plan for managing general anaesthesia in the event of top up failure was sometimes stated [87].…”

Section: Regional Analgesia During Labourmentioning

confidence: 99%

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Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

2020

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We reviewed the literature on management of general and regional anaesthesia in pregnant women with anticipated airway difficulty. We identified 138 publications comprising 158 cases; these either described equipment or techniques for the provision of general anaesthesia, or the management of women with regional analgesia or anaesthesia, with the aim of avoiding general anaesthesia. Most of the former group described women requiring caesarean section alone, or in combination with other surgery, which was sometimes airwayrelated. Management techniques were largely similar to those in non-obstetric patients requiring surgery who have airway difficulties, although suggested differences related to physiological changes of pregnancy and avoidance of nasal intubation. In the reports discussing regional anaesthesia, consideration was often given to the possible requirement for urgent out-of-hours anaesthetic intervention, and the predicted difficulty of management of general anaesthesia should it be required. In a number of reported cases, multidisciplinary planning led to the conclusion that elective caesarean section should be performed in order to avoid emergency airway management. Based on this literature review, we advise antenatal planning that includes: assessment of the patient's clinical characteristics; consideration of the equipment and personnel available to provide safe airway management out-of-hours; and elective caesarean section should these be lacking. If general anaesthesia is required, a risk assessment must be made as to the probability of safe airway management after the induction of anaesthesia, and awake tracheal intubation should be used if this cannot be assured. Decision aids are provided to illustrate these points. Online appendices include a comprehensive compendium of case reports on the management of a number of rare syndromes and airway conditions.

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Section: Resultsmentioning

confidence: 99%

Section: Regional Analgesia During Labourmentioning

confidence: 99%

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Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

2020

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“…In our search of the available literature, we found three cases describing the use of epidural for labor analgesia in patients with KFS, but none for cesarean delivery. [67] In 2001, O’Connor et al . described the successful use of a thoracic epidural for bilateral reduction mammoplasty in a non-pregnant patient with KFS.…”

Section: Discussionmentioning

confidence: 99%

Epidural anesthesia for repeat cesarean delivery in a parturient with Klippel-Feil syndrome

Smith

Ray

2011

J Anaesthesiol Clin Pharmacol

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A patient with Klippel-Feil syndrome, morbid obesity, and scoliosis required cesarean delivery. Her previous cesarean deliveries were performed under general anesthesia. She desired a regional technique. Following aspiration prophylaxis and placement of standard monitors, ultrasound was used to identify midline and L2-3 interspace. Unintentional dural puncture occurred at 10 cm, with an inability to advance the catheter. On second attempt, an epidural catheter was placed easily. After negative test dose, 18 ml of 2% lidocaine with epinephrine was administered to the patient. A T4 level was achieved. The patient tolerated surgery well. Complete block resolution occurred at 4 hours with no neurologic sequelae.

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