Abstract

Introduction: Poliomyelitis, caused by an enterovirus, is a neuromuscular disorder that has been largely eradicated but remains a challenge in some tropical regions. It primarily spreads via the fecal-oral route and damages the motor and autonomic nervous systems. Kyphoscoliosis, characterized by abnormal spinal curvature and rotation in both sagittal and coronal planes, complicates neuraxial anaesthesia and presents significant anaesthetic challenges. Case Report: A 36-year-old female at 39 weeks 4 days gestation was scheduled for an elective caesarean section. She had a history of poliomyelitis with progressive spinal deformity and was short in stature (146 cm, 56 kg) with thoracolumbar scoliosis and a mediastinal shift. Neurologically, she had complete motor paralysis in both lower limbs but no sensory deficits. Her airway was Mallampati grade 4, and lab parameters were normal. High-risk consent was obtained. Due to her spinal deformity, lumbar puncture was challenging. A paramedian approach at L3-L4 with a 25G Quincke needle was used to administer 1.8 ml of 0.5% hyperbaric Bupivacaine and 0.2 ml of 15 mcg Fentanyl. The sensory block initially reached T8 on the right and T12 on the left. After 15 minutes with no improvement, a repeat block with 1 ml of 0.5% hyperbaric Bupivacaine was given. With a left lateral tilt, the block level improved to T6 bilaterally. The caesarean section proceeded without complications, and a healthy baby was delivered. The patient had an uneventful 24-hour postoperative period. Conclusion: In managing anaesthesia for a patient with kyphoscoliosis and poliomyelitis, meticulous preoperative evaluation for skeletal, respiratory, and cardiovascular abnormalities is crucial. In this case, the patient’s stable maternal and fetal condition allowed for a successful spinal anaesthesia despite initial difficulty. Literature supports that a repeat block after 15-20 minutes can be a safer alternative to general anaesthesia in such cases.

• 1.   Kumar R, Singh K, Prasad G, Patel N. Repeat spinal anesthesia after a failed spinal block in a pregnant patient with kyphoscoliosis for elective cesarean section. J ObstetAnaesthCrit Care. 2014 Jul–Dec;4(2):84-6.
• 2.   Korula S, Ipe S, Abraham SP. Parturient with severe kyphoscoliosis: An anesthetic challenge. J ObstetAnaesthCrit Care. 2011 Jul–Dec;1(2):81-4.
• 3.   Kumari BG, Samantaray A, Kumar VA, Durga P, Jagadesh G. Spinal anaesthesia in poliomyelitis patients with scoliotic spine: A case control study. Indian J Anaesth. 2013 Mar; 57(2):145-9.
• 4.   Shrestha A, Gupta S, Singh S, Chaudhary S. Anesthetic management of a parturient with poliomyelitis associated with kyphoscoliosis. Nepal J ObstetGynaecol. 2014;9(1):67-70.
• 5.   Singh R, Sardana R, Singh P. Spinal anaesthesia in kyphoscolioticparturients undergoing caesarean delivery – A retrospective study from a tertiary care centre in India. J ObstetAnaesthCrit Care. 2022 Jul–Dec;12(2):140-3.
• 6.   Moran DH, Johnson MD. Continuous spinal anesthesia with combined hyperbaric and isobaric bupivacaine in a patient with scoliosis. AnesthAnalg. 1990 Apr;70(4):445-7.

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