naa a22 4500 510742858 CHVBK 20180411083034.0 cr unu---uuuuu 180411e20130601xx s 000 0 eng 10.1007/s12630-013-9919-5 doi (NATIONALLICENCE)springer-10.1007/s12630-013-9919-5 Anesthetic management of a parturient with VACTERL association undergoing Cesarean delivery [Elektronische Daten] [Gillian Hilton, Frederick Mihm, Alexander Butwick] Prise en charge anesthésique d'une parturiente atteinte du syndrome de VACTERL subissant un accouchement par césarienne Purpose: We present the anesthetic management of a parturient with VACTERL association undergoing combined regional and general anesthesia for Cesarean delivery. Defined as a syndrome, VACTERL association comprises at least three of the following abnormalities: vertebral, anal atresia, cardiac, tracheoesophageal, renal, and limb. Clinical features: The patient's anatomic abnormalities and comorbidities comprised severe cervicothoracic scoliosis, kyphoscoliosis, congenitally fused ribs, and severe restrictive lung disease. She had a Mallampati class 3 airway, a right laterally flexed neck, and reduced mandibular protrusion. We performed a lumbar spine ultrasound for epidural placement which was used to provide peri- and postoperative analgesia. Due to the anticipated difficult tracheal intubation, the patient underwent an awake fibreoptic intubation and subsequently received general anesthesia. The patient's trachea was extubated on the first postoperative day, and she received adequate post-Cesarean epidural analgesia. Conclusion: This case highlights the challenges that anesthesiologists face when managing parturients at extremely high risk for perioperative anesthetic morbidity due to the presence of severe pre-existing disease, anticipated difficult airway, and major spinal abnormalities complicating neuraxial anesthesia. We used a combined general and epidural anesthetic approach to control ventilation, provide effective postoperative analgesia, and reduce the risk of anesthetic-related perioperative morbidity. An individualized approach should be considered for the anesthetic management of high-risk pregnant patients with complex and multiple medical and surgical morbidities undergoing labour and delivery. Canadian Anesthesiologists' Society, 2013 Hilton Gillian Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Rm H3580, 94305, Stanford, CA, USA aut Mihm Frederick Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Rm H3580, 94305, Stanford, CA, USA aut Butwick Alexander Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Rm H3580, 94305, Stanford, CA, USA aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/6(2013-06-01), 570-576 0832-610X 60:6<570 2013 60 12630 https://doi.org/10.1007/s12630-013-9919-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-9919-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hilton Gillian Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Rm H3580, 94305, Stanford, CA, USA aut NATIONALLICENCE 700 1- Mihm Frederick Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Rm H3580, 94305, Stanford, CA, USA aut NATIONALLICENCE 700 1- Butwick Alexander Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive, Rm H3580, 94305, Stanford, CA, USA aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/6(2013-06-01), 570-576 0832-610X 60:6<570 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer