Department of Anesthesiology, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Anesthesiology, Anyang Maternity and Child Care Center, Anyang City, Henan Province, China.
BMC Pregnancy Childbirth. 2021 Apr 1;21(1):272. doi: 10.1186/s12884-021-03751-3.
The preferable choice of anesthesia for the patients with congenital atlantoaxial dislocation (CAAD) and type I Arnold Chiari malformations (ACM-I) has been a very confusing issue in clinical practice. We describe the successful administration of combined spinal-epidural anesthesia for a woman with CAAD and ACM-1 accompanied by syringomyelia.
Our case report presents the successful management of a challenging obstetric patient with CAAD and ACM-1 accompanied by syringomyelia. She had high risks of difficult airway and aspiration. The injection of bolus drugs through the spinal or epidural needle may worsen the previous neurological complications. The patient was well evaluated with a multidisciplinary technique before surgery and the anesthesia was provided by a skilled anesthesiologist with slow spinal injection.
An interdisciplinary team approach is needed to weigh risks and benefits for patients with CAAD and ACM-1 undergoing cesarean delivery. Therefore, an individual anesthetic plan should be made basing on the available anesthetic equipments and physicians' clinical experience on anesthetic techniques.
对于伴有脊髓空洞症的先天性寰枢椎脱位（CAAD）和Ⅰ型Arnold-Chiari 畸形（ACM-I）患者，选择何种麻醉方式一直是临床实践中的一个非常棘手的问题。我们描述了一例成功应用联合脊-硬联合麻醉的病例，该患者为伴有脊髓空洞症的 CAAD 和 ACM-I 女性。
我们的病例报告介绍了一例伴有脊髓空洞症的 CAAD 和 ACM-I 合并困难气道和误吸高风险的挑战性产科患者的成功管理。通过脊髓或硬膜外针推注单次大剂量药物可能会加重先前的神经并发症。患者在术前通过多学科技术进行了充分评估，由经验丰富的麻醉师进行缓慢的脊髓注射来提供麻醉。
对于行剖宫产术的 CAAD 和 ACM-I 患者，需要多学科团队方法来权衡风险和获益。因此，应根据现有的麻醉设备和医生在麻醉技术方面的临床经验制定个体化的麻醉计划。
