Case report: Utilisation of the paramedian approach to epidural insertion in a case of klippel-feil syndrome
Klippel–Feil Syndrome (KFS) is a complex heterogeneous entity that can result in cervical spondylosis and thoracolumbar vertebral fusion. Combined, these features contribute to both a difficult airway and neuraxial anaesthesia. Previously, these patients required general anaesthesia in the obstetric...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Journal of Obstetric Anaesthesia and Critical Care |
| Subjects: | |
| Online Access: | http://www.joacc.com/article.asp?issn=2249-4472;year=2022;volume=12;issue=1;spage=56;epage=58;aulast=Skelly |
| _version_ | 1798021647030026240 |
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| author | James R Skelly Siaghal MacColgáin |
| author_facet | James R Skelly Siaghal MacColgáin |
| author_sort | James R Skelly |
| collection | DOAJ |
| description | Klippel–Feil Syndrome (KFS) is a complex heterogeneous entity that can result in cervical spondylosis and thoracolumbar vertebral fusion. Combined, these features contribute to both a difficult airway and neuraxial anaesthesia. Previously, these patients required general anaesthesia in the obstetric setting, incorporating advanced airway techniques as the first line. Herein, we describe the novel use of the paramedian approach to epidural anaesthesia in a primigravid woman, with a background of KFS. The patient had a vaginal septum and double cervix and was considered at higher risk of obstetric complications. Antenatal assessment and forward planning within the multidisciplinary team setting were vital in the formulation and provision of safe care for this patient. Neuraxial ultrasound (US), undertaken at preassessment, yielded adequate views of the posterior complex in the paramedian sagittal oblique plane only. An anaesthetic plan with emphasis on early paramedian epidural insertion was thus formulated. The patient was admitted to early labour by the obstetric team. Neuraxial US replicated the previously attained windows and in keeping with the plan, the paramedian approach was utilised with successful insertion on the first attempt. Patient-controlled epidural anaesthesia infusion was utilised over her 6-hour labour with instrumental delivery. Epidural analgesia was maintained with a bilateral T6 sensory block with the patient comfortable throughout. This case study outlines the novel use of the paramedian approach to epidural anaesthesia in a patient with KFS. We also believe it exemplifies the need to pre-assess patients with abnormal spinal anatomy and utilises the neuraxial US to formulate an anaesthetic plan. |
| first_indexed | 2024-04-11T17:18:16Z |
| format | Article |
| id | doaj.art-92c61db6539947b4b3ade7a9629620f6 |
| institution | Directory Open Access Journal |
| issn | 2249-4472 |
| language | English |
| last_indexed | 2024-04-11T17:18:16Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Obstetric Anaesthesia and Critical Care |
| spelling | doaj.art-92c61db6539947b4b3ade7a9629620f62022-12-22T04:12:35ZengWolters Kluwer Medknow PublicationsJournal of Obstetric Anaesthesia and Critical Care2249-44722022-01-01121565810.4103/JOACC.JOACC_72_21Case report: Utilisation of the paramedian approach to epidural insertion in a case of klippel-feil syndromeJames R SkellySiaghal MacColgáinKlippel–Feil Syndrome (KFS) is a complex heterogeneous entity that can result in cervical spondylosis and thoracolumbar vertebral fusion. Combined, these features contribute to both a difficult airway and neuraxial anaesthesia. Previously, these patients required general anaesthesia in the obstetric setting, incorporating advanced airway techniques as the first line. Herein, we describe the novel use of the paramedian approach to epidural anaesthesia in a primigravid woman, with a background of KFS. The patient had a vaginal septum and double cervix and was considered at higher risk of obstetric complications. Antenatal assessment and forward planning within the multidisciplinary team setting were vital in the formulation and provision of safe care for this patient. Neuraxial ultrasound (US), undertaken at preassessment, yielded adequate views of the posterior complex in the paramedian sagittal oblique plane only. An anaesthetic plan with emphasis on early paramedian epidural insertion was thus formulated. The patient was admitted to early labour by the obstetric team. Neuraxial US replicated the previously attained windows and in keeping with the plan, the paramedian approach was utilised with successful insertion on the first attempt. Patient-controlled epidural anaesthesia infusion was utilised over her 6-hour labour with instrumental delivery. Epidural analgesia was maintained with a bilateral T6 sensory block with the patient comfortable throughout. This case study outlines the novel use of the paramedian approach to epidural anaesthesia in a patient with KFS. We also believe it exemplifies the need to pre-assess patients with abnormal spinal anatomy and utilises the neuraxial US to formulate an anaesthetic plan.http://www.joacc.com/article.asp?issn=2249-4472;year=2022;volume=12;issue=1;spage=56;epage=58;aulast=Skellydifficult airwayneuraxial analgesianeuraxial ultrasoundobstetric anaesthesiavertebral fusion |
| spellingShingle | James R Skelly Siaghal MacColgáin Case report: Utilisation of the paramedian approach to epidural insertion in a case of klippel-feil syndrome Journal of Obstetric Anaesthesia and Critical Care difficult airway neuraxial analgesia neuraxial ultrasound obstetric anaesthesia vertebral fusion |
| title | Case report: Utilisation of the paramedian approach to epidural insertion in a case of klippel-feil syndrome |
| title_full | Case report: Utilisation of the paramedian approach to epidural insertion in a case of klippel-feil syndrome |
| title_fullStr | Case report: Utilisation of the paramedian approach to epidural insertion in a case of klippel-feil syndrome |
| title_full_unstemmed | Case report: Utilisation of the paramedian approach to epidural insertion in a case of klippel-feil syndrome |
| title_short | Case report: Utilisation of the paramedian approach to epidural insertion in a case of klippel-feil syndrome |
| title_sort | case report utilisation of the paramedian approach to epidural insertion in a case of klippel feil syndrome |
| topic | difficult airway neuraxial analgesia neuraxial ultrasound obstetric anaesthesia vertebral fusion |
| url | http://www.joacc.com/article.asp?issn=2249-4472;year=2022;volume=12;issue=1;spage=56;epage=58;aulast=Skelly |
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