Background and Aims Internationally obstetric anesthesia guidelines recommend regional over GA for most cesarean deliveries. continuous caudal anesthesia in obstetric anesthesia was first reported in 1943, after which lumbar access to the peridural space became widely used. we report the anesthetic management of a parturient with difficult spine in whom we were able to place a us guided continuous caudal catheter and provide adequate anesthesia for the surgery.
Methods 25 yr old primigravida with 38 weeks gestation, short stature(121.8 cms) with a thoracic gibbus and difficult airway was posted for cesarean section. Mri of the spine could not be done due to financial constraints . Preprocedural scanning of the neuraxis done in view of altered spine anatomy. Spinal anesthesia could not be achieved despite multiple attempts due, since neuraxial scan revealed good view of caudal space, a continuous caudal catheter was placed under ultrasound guidance using 18 G Tuohy needle.
Results A sensory block of T6 and motor block of Bromage scale 4 was achieved with incremental fractionated doses of 16 ml 2% lignocaine with adrenaline. Surgery uneventful with minimal hemodynamic pertubations. Time taken for 2 segment regression of sensory block in this case was around 245 minutes.
Conclusions A continuous caudal catheter placed under ultrasound guidance can be considered as a safe modality for providing anesthesia/analgesia in parturients with a difficult spine anatomy.
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