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///2015 Abstract Details
2015 Abstract Details2019-08-02T16:54:43-05:00

Multi-disciplinary Approach To Neuraxial Anesthesia In A Patient With A Congenital Nevus

Abstract Number: S-78
Abstract Type: Case Report/Case Series

Ty A. Slatton M.D.1 ; Tracey M. Vogel M.D.2

A 34 year old G2P1 parturient at 36 weeks with a large congenital nevus presented for consultation for regional anesthesia for her repeat cesarean section. Her prior cesarean section was performed under general anesthesia due to the complexity and location of her lesion and uncertainty of the safety of regional anesthesia. Significant history included a surgical resection of approximately one third of this lesion in early childhood with resultant regrowth and scar formation. Her previous cesarean section was complicated by severe PONV, difficulty with neonatal bonding, and dissatisfaction with her experience. Her medical history was otherwise unremarkable. Her physical examination was notable for the extensive distribution of her nevus extending from her buttocks to her scapulae, and the marked engorgement of this tissue. The patient stated that the nevus was extremely friable and was prone to bleeding with minimal manipulation. Our patient desired to be awake for this cesarean section to avoid PONV and to allow for earlier neonatal bonding. Two separate dermatologists were consulted and both opinions supported that spinal anesthesia was safe and that there was no significant risk of introducing melanin cells (which could then become malignant) into the CSF. A spinal anesthetic was agreed upon. Prepping for the spinal was extremely challenging given the thick, vascular, torturous nature of the nevus. We utilized several sizes of cotton applicators and a created applicator comprised of a 20 cc syringe and an 18g angio-catheter. A total of 40 cc of betadine was applied. The spinal was successful after only one reposition of the introducer, in a small area of scar at approximately L2-L3. A T4 anesthetic level was achieved and the patient underwent a successful cesarean section under regional anesthesia. No PONV was noted and she proceeded to breast feed and bond with her neonate almost immediately. The advanced multidisciplinary approach to her care improved her overall satisfaction and allowed for an improved mother-baby environment.

SOAP 2015