Sub arachnoid block for emergency cesarean section in a pituitary dwarf

Area of Science:

• Anesthesiology
• Obstetrics
• Endocrinology

Background:

• Anesthetic management for parturients with dwarfism presents unique challenges, with ongoing debate between general and regional anesthesia.
• Limited availability of epidural or continuous epidural anesthesia facilities in many centers complicates anesthetic choices.
• Pituitary dwarfism in a parturient requires careful consideration due to potential anatomical and physiological variations.

Observation:

• A 27-year-old primiparous woman (124 cm, 37 kg) with pituitary dwarfism presented for emergency cesarean section due to fetal distress and maternal respiratory compromise.
• The patient had pre-existing cephalopelvic disproportion and was diagnosed with pituitary dwarfism antenatally.
• Immediate anesthetic intervention was required, with a lack of facilities for epidural anesthesia.

Findings:

• Successful emergency cesarean section was performed under sub-arachnoid block (SAB).
• A dose of 7.5 mg (1.5 ml) of 0.5% heavy bupivacaine was administered at the L3-L4 interspace.
• Adequate sensory block and analgesia were achieved, facilitating the surgical procedure without complications.

Implications:

• Sub-arachnoid block (SAB) is a safe and effective anesthetic technique for cesarean sections in patients with dwarfism, particularly when epidural services are limited.
• This case underscores the importance of considering SAB as a primary regional anesthetic option in resource-limited settings for parturients with dwarfism.
• The successful management provides a potential guideline for anesthesiologists facing similar complex obstetric cases.