Anesthesia Discussion > Regional Anesthesia

prolonged paralysis after spinal anesthesia in a patient with poliomyelitis

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drjunc2000:
     i had a 37 year old patient with child-onset poliomyelitis who underwent ceasarean section under Bupivacaine Heavy spinal anesthesia. The procedure itself was uneventful however patient complained of prolonged paralysis for a week after the procedure. Pre-operatively the patient's motor status was 2/5 on both lower extremities but became 0-1/5 after the procedure...any thoughts...Is polio considered an absolute /relative contraindication to spinal anesthesia

Sandy Hancock:
Polio would be pretty much an absolute contra-indication in my book. Did she recover back to her pre-op level of function eventually?

drjunc2000:
yes  she eventually did after 2 months of rehab...

alroth:
We have an interesting case few years ago... see below...

TITLE PAGE
“Cesarean Section in Post-Polio Patient – Case Report”
Gastão D. Neto, MD, PhD – Chief of Anaesthesia Department from Universidade Federal de Pelotas - RS –Brasil.
Florentino F. Mendes, MD, PhD – Chief of Anaesthesia Department from  Irmandade Santa Casa de Misericórdia de Porto Alegre – RS – Brasil.
Alexandre R. de Oliveira, MD – Assistant Anaesthesist from Irmandade Santa Casa de Misericórdia de Porto Alegre – RS – Brasil.
Corresponding author:
Alexandre Roth de Oliveira – alroth@terra.com.br
Rua Duque de Caxias, 833/ 404.Centro - Porto Alegre – RS – Brasil - 90010-282.
Phone and Fax Number: (51) 3228.3210.
 
ABSTRACT
Objective: Although many post-polio survivors have got great anatomical and physiological problems that increase your anesthetic risk, sometimes they present only minimal sequelae that difficult the correct evaluation and anaesthesia procedure. The objective is bringing up the anesthetic evaluation and procedure in similar settings through this case. Case Report: A 26-yr-old primigravida patient, ASA I, 39 wk gestation presented with 24 hs premature rupture of membranes, without active labor. She had been in anesthetic clinic 2 wk before and had described poliomielytis with 1-yr-old and “complete recovering”. With 16-yr-old she was submitted to apendicectomy through spinal anesthesia with “weakness” in entire body for approximately 24 hs. At physical examination the only sign was shorter Aquiles tendon of both legs. After volume expansion, the choice was an epidural anesthesia with 15 ml of bupivacaine 0,3% (without epinephrine) and morphine 2 mg. No epidural catheter was placed in. After 4 minutes was initiated the surgery with T4 sensitive level and hipotension/ taquicardia corrected with metaraminol 1 mg. After 50 minutes the procedure was finished with the same anesthesia picture. The entire recovering from anesthesia has occurred after 11 hs. An elevated consume of analgesics (NSAIDS and opioids) and antemetics was observed. Conclusions: This case report describes the fewest practical concepts available about regional anesthesia in post-polio patients with minimal sequelae: the lower dose of local anesthetic, the attention with potential cardiac arritmias (avoiding epinephrine) and the accentuation of emesis and pain. The importance of communications about these “minimal” cases and the anesthetic conducts in this setting are debated.
Key Words: Post-polio, epidural anesthesia, pain, cesarean section.

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