Kiyosawa Kenkichi, Kawamata Tomoyuki, Yamamoto Katsumi, Kawamata Mikito
Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto 390-8621.
Masui. 2013 Jul;62(7):859-62.
An emergency caesarean section was performed in a 38-year-old parturient with pregnancy-induced hypertension at week 31 of gestation because of nonreassuring fetal status. A chest X-ray revealed mild spinal scoliosis. We attempted a combined spinal-epidural anesthesia in the parturient because the Cobb angle was only 28 degrees. However, we failed to achieve epidural puncture at the T12-L1 and L1-2 interspaces using a paramedian approach. In addition, we failed to achieve the puncture of the subarachnoid spaces at L3-4 and L4-5 using medial and paramedian approaches. Finally, we succeeded in puncturing the subarachnoid space at L5-S1 using the median approach, and injected 11 mg of hyperbaric bupivacaine. Analgesia was achieved from the T6 to S regions, and the caesarean section was completed uneventfully. A postoperative X-ray and computed tomography scan revealed that the rotation of the lumbar spine was so severe that the spaces between the laminae of the lumbar regions were shifted to the left and narrowed. Therefore, the puncture of the epidural and subarachnoid spaces was difficult, suggesting that the degree of lumbar spine rotation is more important than the thoracic spine curvature for successful epidural and spinal anesthesia in parturients with scoliosis.
一名38岁的妊娠高血压产妇在妊娠31周时因胎儿状况不佳接受了急诊剖宫产。胸部X线检查显示轻度脊柱侧弯。由于科布角仅为28度，我们尝试对该产妇实施腰麻-硬膜外联合麻醉。然而，我们采用旁正中入路在T12-L1和L1-2椎间隙未能成功进行硬膜外穿刺。此外，我们采用正中入路和旁正中入路在L3-4和L4-5椎间隙也未能成功穿刺蛛网膜下腔。最后，我们采用正中入路在L5-S1成功穿刺蛛网膜下腔，并注入11毫克重比重布比卡因。镇痛平面达到T6至骶部区域，剖宫产手术顺利完成。术后X线和计算机断层扫描显示腰椎旋转严重，腰椎椎板间隙向左移位且变窄。因此，硬膜外和蛛网膜下腔穿刺困难，提示对于脊柱侧弯产妇，腰椎旋转程度比胸椎曲度对腰麻和硬膜外麻醉成功更重要。
