Ultrasound-guided epidural anesthesia for a parturient with severe malformations of the skeletal system undergoing cesarean delivery: a case report

LinLi Luo,* Juan Ni,* Lan Wu, Dong Luo Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China  *These authors contributed equally to this work and should be considered co-first authors Abstract: Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients' complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided epidural anesthesia was performed in the L1–L2 space, followed by an intravenous administration of ketamine (0.5 mg/kg) for sedation and analgesia. Satisfactory anesthesia was provided to the patient and spontaneous ventilation was maintained during the surgery. The mother and the baby were discharged 5 days after surgery, no complications were reported for either of them. Our work demonstrated that an ultrasound-guided epidural anesthesia combined with low-dose ketamine can be used to successfully maintain spontaneous ventilation and provide effective analgesia during surgery and reduce the risk of postoperative anesthesia-related pulmonary infection. Keywords: anesthesia, regional, cesarean delivery, ketamine, ultrasound-guided