Okutomi Toshiyuki, Saito Miwako, Koura Makiko, Hoka Sumio
Department of Anesthesiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara 228-8555, Japan.
J Anesth. 2006;20(3):223-6. doi: 10.1007/s00540-006-0405-x.
This case report demonstrates the successful anesthetic management of cesarean section for a 29-year-old primiparous parturient with a past history of a scoliosis operation at 13 years of age. An Isola hook and screw-rod system had been implanted as posterior spinal instrumentation at the level of T3-L3. We titrated hyperbaric bupivacaine 7 mg combined with fentanyl 15 microg through a continuous spinal catheter, placed with a catheter-over-needle technique in order to avoid unintentional wide spread of anesthetic agents. The anesthetic level was T4 at the start of the operation. Her surgery was carried out without any problems. Headache, as a dural tap-related complication, was not observed. Spinal anesthesia with the titration of anesthetic agents for cesarean section is considered to be one of the choices for a parturient who has had spinal instrumentation.
本病例报告展示了对一名29岁初产妇剖宫产的成功麻醉管理，该产妇13岁时有脊柱侧弯手术史。曾植入Isola钩和螺钉棒系统作为T3 - L3节段的后路脊柱内固定器械。我们通过连续脊麻导管滴定7 mg重比重布比卡因与15 μg芬太尼的混合液，采用针内导管技术放置导管以避免麻醉药物意外广泛扩散。手术开始时麻醉平面为T4。她的手术顺利进行，未观察到作为硬膜穿破相关并发症的头痛。对于有脊柱内固定器械植入史的产妇，滴定麻醉药物的脊麻被认为是一种选择。
