Department of Anesthesiology, CHU Sainte Justine, University of Montreal, Chemin de la Côte-Sainte-Catherine, Montreal, QC, Canada.
Can J Anaesth. 2012 Sep;59(9):871-4. doi: 10.1007/s12630-012-9745-1. Epub 2012 Jul 18.
Ankylosing spondylitis (AS) is a chronic progressive multisystemic disease. Patients with AS present a specific set of anesthesia-related challenges, and the parturient with AS presents particular anesthetic considerations. We report our experience with a parturient with advanced AS and offer a novel explanation for the high incidence of epidural failures in this patient population.
We present the case of a 36-yr-old primigravida parturient with a very difficult airway and a history of severe AS. The initial treatment plan was to use a continuous epidural for labour analgesia. Despite two successful placements of lumbar epidural catheters, adequate rostral spread of local anesthesia to control her labour pain was never achieved via the epidural route. Thus, continuous spinal anesthesia was used, which provided effective labour analgesia in this patient.
We hypothesize that this patient's advanced calcified posterior longitudinal ligament caused a physical barrier to rostral spread of local anesthesia solution within her epidural space. This hypothesis is supported by a recent study highlighting the importance of this ligament in allowing adequate distribution of solution within the epidural space. In addition, the successful use of continuous spinal analgesia adds to the growing body of literature supporting the safety and efficacy of intrathecal catheters for labour analgesia in specific situations.
强直性脊柱炎（AS）是一种慢性进行性多系统疾病。AS 患者存在一系列特定的与麻醉相关的挑战，而 AS 产妇则存在特殊的麻醉考虑因素。我们报告了一例晚期 AS 产妇的病例，并对该患者人群中硬膜外失败发生率高的原因提出了新的解释。
我们报告了一例 36 岁初产妇的病例，该产妇存在严重的气道困难和 AS 病史。最初的治疗计划是使用连续硬膜外麻醉进行分娩镇痛。尽管两次成功放置了腰椎硬膜外导管，但从未通过硬膜外途径实现足够的局部麻醉药向头端扩散以控制其分娩疼痛。因此，使用了连续脊髓麻醉，为该患者提供了有效的分娩镇痛。
我们假设该患者严重的骨化后纵韧带导致其硬膜外腔内局部麻醉溶液向头端扩散的物理屏障。这一假设得到了最近一项研究的支持，该研究强调了该韧带在允许局部麻醉溶液在硬膜外腔内充分分布方面的重要性。此外，连续脊髓镇痛的成功应用增加了越来越多的文献支持在特定情况下使用鞘内导管进行分娩镇痛的安全性和有效性。
