Khakurel Sharad, Yadav Rupesh Kumar
National Academy of Medical Sciences, National Trauma Centre, Kathmandu, Nepal.
Case Rep Anesthesiol. 2021 Apr 9;2021:6644894. doi: 10.1155/2021/6644894. eCollection 2021.
The practice of continuous spinal anaesthesia is not common. Though underutilised, it offers significant advantage when compared to the single-shot technique nonetheless. Time and again, it has proven its worth in patients with advanced cardiac illness, spinal deformities, and obesity. We here successfully employed this neuraxial anaesthetic technique in a sixty-two-year-old male patient with skeletal dysplasia, who presented for surgical fixation of intertrochanteric fracture of the femur. With short stature, anticipated difficult airway, and poor pulmonary status complicating the anaesthetic plan, we opted for continuous spinal anaesthesia. The procedure was carried out uneventfully with 8 mg of hyperbaric bupivacaine used in titration to anaesthetic needs. Patients with skeletal dysplasia present with wide array of clinical conditions that pose a formidable challenge to anaesthesiologists. Continuous spinal anaesthesia can be safely practiced in such patients as it provides a titratable form of neuraxial blockade with reduced dose of local anaesthesia. This, in turn, ensures a predictable block and, thus, hemodynamic stability.
连续脊麻的应用并不常见。尽管未得到充分利用,但与单次注射技术相比,它仍具有显著优势。它一次又一次地在患有晚期心脏病、脊柱畸形和肥胖症的患者中证明了其价值。我们在此成功地将这种神经轴麻技术应用于一名62岁患有骨骼发育异常的男性患者,该患者因股骨粗隆间骨折前来接受手术固定。由于身材矮小、预计气道困难以及肺部状况不佳使麻醉计划复杂化,我们选择了连续脊麻。手术过程顺利,使用8毫克重比重布比卡因根据麻醉需要进行滴定。患有骨骼发育异常的患者存在多种临床情况,这给麻醉医生带来了巨大挑战。连续脊麻可以在此类患者中安全实施,因为它提供了一种可滴定的神经轴阻滞形式,且局部麻醉药剂量减少。这反过来又确保了可预测的阻滞,从而保证了血流动力学稳定性。