Nguyen T T, Papadakos P J, Sabnis L U
Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, NY 14642, USA.
Reg Anesth. 1997 Jan-Feb;22(1):102-4. doi: 10.1016/s1098-7339(06)80063-5.
A 66-year-old achondroplastic male dwarf with right ureteral stones presented for outpatient extracorporeal shock wave lithotripsy under epidural anesthesia.
The patient had marked lumbar lordosis and mild thoracic kyphosis. Although the epidural space was located easily at the L2-3 interspace on the first attempt, the catheter could not be advanced beyond the Tuohy needle. On the second attempt, the epidural space was located easily at the L1-2 interspace, and the catheter was advanced without difficulty.
A sensory block to the T2 level developed after administration of 2 mL of lidocaine 1.5% with epinephrine 1:200,000 and 9 mL of lidocaine 2.0% with epinephrine 1:200,000. Aside from a short period of mild, asymptomatic hypotension, the patient's intraoperative and postoperative courses were unremarkable.
This case report and the available literature support the feasibility of epidural anesthesia in achondroplastic patients. Careful titration of the local anesthetic dose is recommended since achondroplastic patients may have extensive spread of epidural anesthesia.
一名66岁的软骨发育不全男性侏儒症患者，患有右输尿管结石，拟在硬膜外麻醉下行门诊体外冲击波碎石术。
患者有明显的腰椎前凸和轻度胸椎后凸。尽管首次尝试时很容易在L2 - 3间隙定位硬膜外腔，但导管无法推进到Tuohy针之外。第二次尝试时，很容易在L1 - 2间隙定位硬膜外腔，导管顺利推进。
给予2 mL 1.5%利多卡因加1:200,000肾上腺素和9 mL 2.0%利多卡因加1:200,000肾上腺素后，出现T2水平的感觉阻滞。除了短时间轻度、无症状的低血压外，患者的术中和术后过程均无异常。
本病例报告及现有文献支持软骨发育不全患者行硬膜外麻醉的可行性。由于软骨发育不全患者的硬膜外麻醉可能会广泛扩散，建议谨慎滴定局部麻醉药剂量。
