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Point-of-Care Ultrasound for Obstetric Anesthesia Care: Case Report
Abstract Number: SUN-74
Abstract Type: Case Report/Case Series
Ultrasound has been used widely as a point-of-care imaging modality for clinical care. We report a parturient who had lumbar surgery history arrived for consultation for anesthesia care for her upcoming delivery.
A 36-year-old G2P0 woman was referred by her obstetrician to the obstetric anesthesia consult at 29w5d gestation. She reported that she had a history of herniated lumbar disk and underwent a very complex lumbar spine operation 10 years ago in the midwest. She could not recall the detailed hospital name. In 2015, at age of 34, she had been through an abdominal myomectomy operation under general anesthesia. On examination, there were no obvious abnormalities of airway, lungs, cardiac and lower extremities, except for a skin scar on her lower back.
We used ultrasound to examine her lumbar spine. Bilateral Harrington rods were identified on bilateral L4-L5-S1 levels, which cleared her mid and upper lumbar spine for potential neuraxial approach for her upper coming labor and delivery.
For completion of medical documentation, a medical record release request was sent out for her past medical record. Upon multiple search and telephone calls, we identified the hospital where she received her past medical care. The old record indicated that she has ungenerative disk disease with complex posterior lumbar interbody fusion L4-S1 with fresh frozen femoral allograft and infusion. An old CT lumbar scan was received which showed the Harrington rods were inserted from the level of L4 to the level of S1. We counsel the patient for potential neuraxial anesthesia/analgesia.
In parturient with spinal surgery in lumbosacral region, neuraxial analgesia and/or anesthesia should still be considered. Although cross cut image may not always show rods clearly, sagittal images usually can easily identify the screws and give the long axis of the rods. The patient is estimated to be induced on March 17, 2017. We will report our analgesia/ anesthesia experience on her at the SOAP meeting.
1. Crosby ET, Halpern SH. Obstetric epidural anaesthesia in patients with Harrington instrumentation. Can J Anaesth 1989; 36: 693–6.
2. Herbert CH. Epidural anesthesia in patients with spinal fusion. Anesth Analg 1985; 64; 83.