Background and Aims Achondroplasia accounts for approximately 70% of all forms of dwarfism. Cesarean delivery is often required in parturients with achondroplasia due to cephalopelvic disproportion. Given the challenges for both regional and general anesthetic techniques, there is no consensus on the optimal anesthetic management for cesarean delivery in these patients. The aim of this study was to explore the literature for prior case reports and series to determine the optimum anesthetic management for cesarean delivery in achondroplastic patients.
Methods We conducted a review of the literature using Embase, Medline, and Scopus database searches for case series and case reports on achondroplasia and pregnancy through May 2023. Extracted data included demographic information, anesthetic management, and reported complications. Institutional IRB exemption was obtained.
Results Literature review resulted in 49 manuscripts with a total of 62 anesthetics. Anesthetic management consisted of general anesthesia (n=15) (table 1), single injection spinal (n=23), epidural catheter (n=13), combined spinal-epidural (n=10), and intrathecal catheter (n=1) (table 2). Reduced dose of bupivacaine was common, and few complications were reported.
Conclusions Despite the risks attributed to general anesthesia in parturients, it was historically the preferred anesthetic management in achondroplastic patients due to unpredictable spinal anatomy and unreliable local anesthetic spread. We describe a review of the literature in which neuraxial anesthesia is increasingly more common and a viable option in carefully selected parturients with achondroplasia. Reduction of intrathecal local anesthetic that minimizes the risk of high spinal and emergent intubation, as well as a titratable neuraxial technique can be effective in this patient population.
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