Case report
Anaesthetic Management of a Patient with Severe Thoracolumbar Kyphoscoliosis Undergoing Exploratory Laparotomy for a Large Ovarian Cyst: A Case Report
UD05-UD08
Correspondence
Charmi Hitenbhai Shah,
20, Netaji Society, Near Muktanand, Karelibaug, Vadodara, Gujarat, India.
E-mail: charmi28shah@gmail.com
Severe thoracolumbar kyphoscoliosis usually makes anaesthesia difficult. The chest is deformed, the lungs work poorly, and the twisted spine is hard to reach for a neuraxial block. A 30-year-old woman with this deformity presented with a large ovarian cyst and was listed for open abdominal surgery. Before this illness she could carry out her routine household work (about four metabolic equivalents) but became breathless on climbing one flight of stairs (modified Medical Research Council dyspnoea grade 2). Her chest radiograph showed a double curve, with the thoracic spine bent to the right at a Cobb’s angle of 74 degrees and the lumbar spine to the left at 64 degrees. Lung function testing showed a severe restrictive pattern, and her breathing did not improve after a bronchodilator. The heart scan and the rest of the workup were normal. General anaesthesia in a patient with such poor lung reserve carries a real risk of breathing trouble after surgery, so a spinal block was chosen instead, even though the distorted anatomy made it harder. The landmarks were felt for patiently, and the block was placed in the sitting position at the L3-L4 space. A dose of 3.8 mL of 0.5 percent heavy bupivacaine with 10 micrograms of dexmedetomidine was given. A sensory level of T6 was reached. She stayed stable through the whole operation, with no drop in oxygen and no swings in blood pressure, and her recovery was smooth. This case shows that a spinal block, planned with care and placed with patience, can be a safe option for major abdominal surgery in a patient with severe kyphoscoliosis and weak lungs.