Combined spinal epidural anaesthesia for elective caesarean section in a patient with spondylometaphyseal dysplasia.

A patient with spondylometaphyseal dysplasia, an extremely rare form of dwarfism, presented for elective caesarean section. We report the successful management under regional anaesthesia, using a combined spinal epidural technique. There seem to be only two previous reports of spinal anaesthesia and there are no previous reports of the use of combined spinal epidural in a pregnant dwarf. Regional anaesthesia is thought to be complex in these dwarfs due to vertebral malformation and unpredictable anatomy of the spinal canal. They may present difficulties with intubation as well. Spondylometaphyseal dysplasia is reviewed and its anaesthetic implications discussed.