A case report on anaesthetic management of patient with bilateral retinitis pigmentosa with partial blindness for abdominal hysterectomy: Sequential combined spinal epidural anaesthesia in era of COVID19 pandemic

Abstract

Retinitis pigmentosa is typically bilateral and symmetric. There is currently no treatment that can stop the process of retinitis pigmentosa, but gene therapy shows promise. Retinitis pigmentosa is typically a bilateral, progressive retinal degeneration that ultimately leads to death of both rod and the cone photoreceptors. Retinitis pigmentosa is generally symmetric, but can present asymmetrically. Other complications associated with retinitis pigmentosa include posterior subcapsular cataracts and cystoid macular edema, retinal detachment [1]. Forty-five separate gene loci have been identified that account for 50% of all bilateral retinitis pigmentosa cases. In addition, between 20-30% of patients with bilateral retinitis pigmentosa have an associated systemic disease, with more than 30 syndromes identified? The most widely known associated syndrome, Usher Syndrome, results in retinitis pigmentosa and hearing impairment. Other syndromes associated with retinitis pigmentosa are Laurence-Moon-Bardet-Biedl syndrome, Bardet-Biedl syndrome. We report the case of Retinitis pigmentosa with partially blind patient for Total abdominal hysterectomy managed by Sequential combined Spinal Epidural Anaesthesia (Sequential CSEA) in the era of COVID Pandemic inorder to avoid drastic changes in blood pressure thus preventing drastic change in intraocular pressure as intraocular pressure is a determining factor in partially blind patient with progressive retinitis pigmentosa. Sequential combined spinal epidural anaesthesia is a very safe regional anaesthesia technique to avoid General anaesthesia thus preventing abrupt increase in intraocular pressure and aerosol generation in era of COVID Pandemic. Sequential combined spinal epidural anaesthesia (Sequential CSEA) is probably the greatest advance in central neuraxial block. Sequential combined spinal epidural anaesthesia is a safe, effective, reliable technique with stable haemodynamic along with provision of prolonging analgesia compared to spinal anaesthesia alone for high risk patients.