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From the Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Address correspondence to: Dr. J.F. Costello, Department of Anesthesia and Pain Management, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada. Phone: 416-586-5270; Fax: 416-586-8664; E-mail: joeycos{at}eircom.net
Purpose: To describe the anesthetic implications, and management of a medically complex parturient, who presented for Cesarean delivery (CD). The patient had poliomyelitis complicated with severe kyphoscoliosis, which had been treated with extensive spinal surgery. We used ultrasound guidance to facilitate successful spinal analgesia and anesthesia.
Clinical features: A 27-yr-old woman, with a history of poliomyelitis and moderate restrictive lung disease secondary to kyphoscoliosis, presented at 38 weeks gestation for elective CD because of cephalopelvic disproportion. The woman had Harrington rods in situ from the level of the second thoracic vertebra, to the level of the fourth lumbar vertebra. Ultrasound guidance enabled one intervertebral space to be visualized (L5-S1), 3 cm from the expected spinal midline, and spinal anesthesia was performed at this interspace without any complications. A healthy infant was delivered, and the mother recovered uneventfully.
Conclusions: Spinal anesthesia can be effectively performed in patients with poliomyelitis and severe kyphoscoliosis, that has been treated with extensive Harrington instrumentation. To facilitate regional techniques in such patients, bedside ultrasound may be greatly beneficial in identifying the correct spinal interspace.
1 Dalakas MC, Elder G, Halett M, et al. A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms. N Engl J Med 1986; 314: 959–63.[Abstract]
2 Rutty CJ. The middle-class plague: epidemic polio and the Canadian state, 1936–37. Can Bull Med Hist 1996; 13: 277–314.[Medline]
3 de Gourville E, Duintjer Tebbens RJ, Sangrujee N, Pallansch MA, Thompson KM. Global surveillance and the value of information: the case of the global polio laboratory network. Risk Anal 2006; 26: 1557–69.[Medline]
4 Yeo ST, French R. Combined spinal-epidural in the obstetric patient with Harrington rods assisted by ultrasonography. Br J Anaesth 1999; 83: 670–2.
5 Grau T, Leipold RW, Conradi R, Martin E. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand 2001; 45: 766–71.[Medline]
6 Melnick JL. Current status of poliovirus infections. Clin Microbiol Rev 1996; 9: 293–300.[Abstract]
7 Lobben B. The history of poliomyelitis in Norway-disease, society and patients (Norwegian). Tidsskr Nor Laegeforen 2001; 121: 3574–7.[Medline]
8 Dalakas MC. The post-polio syndrome as an evolved clinical entity. Definition and clinical description. Ann N Y Acad Sci 1995; 753: 68–80.[Medline]
9 Lambert DA, Giannouli E, Schmidt BJ. Postpolio syndrome and anesthesia. Anesthesiology 2005; 103: 638–44.[Medline]
10 Veiby G, Daltveit AK, Gilhus NE. Pregnancy, delivery and perinatal outcome in female survivors of polio. J Neurol Sci 2007; 258: 27–32.[Medline]
11 Crosby ET, Halpern SH. Obstetric epidural anaesthesia in patients with Harrington instrumentation. Can J Anaesth 1989; 36: 693–6.
12 Magi E, Recine C, Klockenbusch B, Cascianini EA. A postoperative respiratory arrest in a post poliomyelitis patient. Anaesthesia 2003; 58: 98–9.[Medline]
13 Janda A, Urschutz L. Postoperative respiratory insufficiency in patients after poliomyelitis (German). Anaesthesist 1979; 28: 249.[Medline]
14 Wernet, A, Bougeois B, Merckx P, Paugam-Burtz C, Mantz J. Successful use of succinylcholine for cesarean delivery in a patient with postpolio syndrome. Anesthesiology 2007; 107: 680–1.[Medline]
15 Gyermek L. Increased potency of nondepolarizing relaxants after poliomyelitis. J Clin Pharmacol 1990; 30: 170–3.[Abstract]
16 Higashizawa T, Sugiura J, Takasugi Y. Spinal anesthesia in a patient with hemiparesis after poliomyelitis (Japanese). Masui 2003; 52: 1335–7.[Medline]
17 Ho AM, Ngan Kee WD, Chung DC. Should laboring parturients with Harrington rods receive lumbar epidural analgesia? Int J Gynaecol Obstet 1999; 67: 41–3.[Medline]
18 Grau T, Bartusseck E, Conradi, Martin E, Motsch J. Ultrasound imaging improves learning curves in obstetric epidural anesthesia: a preliminary study. Can J Anesth 2003; 50: 1047–50.
19 Arzola C, Davies S, Rofaeel A, Carvalho JC. Ultrasound using the transverse approach to the lumbar spine provides reliable landmarks for labor epidurals. Anesth Analg 2007; 104: 1188–92.
20 Grau, T, Leipold RW, Conradi R, Martin E, Motsch J. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth 2002; 14: 169–75.[Medline]
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