Elective cesarean delivery in a parturient with Klippel–Feil syndrome

Kavanagh, T.; Jee, Rou-Chen; Kilpatrick, NM; Douglas, Joanne

doi:10.1016/j.ijoa.2013.06.005

Cited by 12 publications

(15 citation statements)

References 13 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%

“…However, the time required, even in expert hands, is likely to be significantly longer than for rapid sequence induction [150]. It is clear that there is not a 'recipe book' approach to more complex cases, as the patient, professionals, practice and facilities will all vary on an individual basis [46,85,125].…”

Section: Discussionmentioning

confidence: 99%

“…In the event, laryngoscopy was straightforward and regional anaesthesia was performed [138]. Kavanagh et al also provided topical local anaesthesia to the airway, but on reviewing their case afterwards, the authors concluded that this was mistaken; by the time that intubation would have been required, the local anaesthetic application would have had to be repeated [125].…”

Section: Regional Anaesthesia For Caesarean Section and Nonairway Surgerymentioning

confidence: 99%

“…Two anatomical spaces have to be located, although this is assisted with the needlethrough-needle combined spinal-epidural technique, as the epidural needle acts as a guide for the spinal. On the other hand, this technique means that the epidural catheter may not be tested until it is too late to correct its position [125].…”

Section: Regional Anaesthesia For Caesarean Section and Nonairway Sur...mentioning

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: Discussionmentioning

confidence: 99%

Section: Regional Anaesthesia For Caesarean Section and Nonairway Surgerymentioning

confidence: 99%

Section: Regional Anaesthesia For Caesarean Section and Nonairway Sur...mentioning

confidence: 99%

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

2020

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“…23-28 Patient anatomical characteristics including increased body mass index, 29,30 congenital spinal malformations, 31-34 advanced age, 35 and previous spine surgery 36-39 can make localization of the epidural space difficult. While the accidental dural puncture rate most commonly reported is 1-2%, it has been reported to be as high as 6%.…”

Section: Introductionmentioning

confidence: 99%

Raman Spectroscopy Differentiates Each Tissue from the Skin to the Spinal Cord

et al. 2016

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Background Neuraxial anesthesia and epidural steroid injection techniques require precise anatomical targeting to ensure successful and safe analgesia. Previous studies suggest that only some of the tissues encountered during these procedures can be identified by spectroscopic methods, and no previous study has investigated the use of Raman, diffuse reflectance, and fluorescence spectroscopies. The authors hypothesized that real-time needle-tip spectroscopy may aid epidural needle placement and tested the ability of spectroscopy to distinguish each of the tissues in the path of neuraxial needles. Methods For comparison of detection methods, the spectra of individual, dissected ex vivo paravertebral and neuraxial porcine tissues were collected using Raman spectroscopy (RS), diffuse reflectance spectroscopy, and fluorescence spectroscopy. Real-time spectral guidance was tested using a 2-mm inner-diameter fiber-optic probe-in-needle device. Raman spectra were collected during the needle’s passage through intact paravertebral and neuraxial porcine tissue and analyzed afterward. The RS tissue signatures were verified as mapping to individual tissue layers using histochemical staining and widefield microscopy. Results RS revealed a unique spectrum for all ex vivo paravertebral and neuraxial tissue layers; diffuse reflectance spectroscopy and fluorescence spectroscopy were not distinct for all tissues. Moreover, when accounting for the expected order of tissues, real-time Raman spectra recorded during needle insertion also permitted identification of each paravertebral and neuraxial porcine tissue. Conclusions This study demonstrates that RS can distinguish the tissues encountered during epidural needle insertion. This technology may prove useful during needle placement by providing evidence of its anatomical localization.

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Perioperative management of a parturient with VACTERL association for a caesarean section

Tonks

Birch

Ito

et al. 2023

Anaesthesia Reports

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Summary A parturient with VACTERL association (vertebral defects, anal atresia, cardiac defects, trachea‐oesophageal fistula, renal abnormalities and limb abnormalities) was listed for an elective caesarean section. She had a short neck with reduced cervical extension and flexion. Magnetic resonance imaging of her whole spine was performed which showed failure of cervical spine segmentation and cervical stenosis. Neuraxial blockade could have resulted in unpredictable spread of local anaesthetic due to the low volume of the spinal canal, and could have caused myelopathic changes within the spinal cord due to cerebrospinal fluid pressure changes. A general anaesthetic using a rapid sequence induction was also predicted to be challenging due to her fixed, unstable neck and severe cervical spine stenosis. After a multidisciplinary discussion Including neurosurgeons, we planned for awake tracheal intubation followed by general anaesthesia. However, before the date of her planned delivery, she required an urgent caesarean section due to severe preeclampsia. This was performed under general anaesthesia following uncomplicated awake tracheal intubation.

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Elective cesarean delivery in a parturient with Klippel–Feil syndrome

Cited by 12 publications

References 13 publications

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

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

Raman Spectroscopy Differentiates Each Tissue from the Skin to the Spinal Cord

Perioperative management of a parturient with VACTERL association for a caesarean section

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