Complicated Neuraxial Anesthesia in a Patient With Tethered Spinal Cord

Abstract

Spinal anesthesia is a common anesthetic used in many surgical procedures. Anatomical variations and diseases make this procedure require extra considerations. Extra care should be taken into consideration in the pre-anesthesia evaluation when neuraxial anesthesia is planned.We present the case of a patient undergoing cesarean section for the arrest of labor, who had a complicated labor course due to unrecognized history of a tethered spinal cord leading to inadequate analgesia, requiring replacement of epidural analgesia and spinal anesthesia. Ultimately, the decision was made to proceed with general anesthesia due to the patient's discomfort. Exhaustive chart review after surgery showed a past MRI with evidence of a tethered spinal cord.

Manejo anestésico para cesárea en una parturienta con síndrome de médula anclada. Reporte de caso

“…Su ventaja frente a la anestesia general es la capacidad de lograr una anestesia más efectiva sin necesidad de fármacos intravenosos, confiriendo mayor estabilidad hemodinámica y menores efectos secundarios en el feto. En el caso del SMA pueden existir tabiques fibróticos fusionados a estructuras epidurales por lo que se dificulta la difusión del anestésico local tanto intradural como epidural, impidiendo alcanzar el nivel de analgesia deseado [11].…”