脊椎矯正術後の妊婦に対する帝王切開において超音波補助下に脊髄くも膜下麻酔を施行した1症例

Ultrasound-assisted Spinal Anesthesia for Cesarean Section in a Parturient after Spinal Fusion Surgery

要旨

　脊椎矯正術後の妊婦の帝王切開術の麻酔管理を経験した。ランドマークの消失や術後の癒着による腰椎穿刺困難が予想されたが，過去のX線写真の所見と実際の穿刺体位での超音波診断で穿刺部位を決定し，脊髄くも膜下麻酔による管理が可能であった。脊椎手術後の腰椎穿刺において超音波診断は有用である。

　A 34-year-old woman who had undergone spinal fusion surgery for kyphosis was scheduled for cesarean section. Epidural catheter placement was abandoned owing to predicted adhesions in the epidural space, and spinal anesthesia was planned. Since blind puncture using superficial landmarks was anticipated to be difficult, the puncture site was determined using ultrasonography in the actual puncture position based on the positional relationship between the metal implants and the vertebral interspaces on the X-ray. We were able to successfully perform spinal anesthesia for cesarean section in patients after spinal fusion surgery.