Bilateral Loss of Vision after Spinal Anaesthesia on a Dwarf Patient

Kassa Mw,Opondo Pr,Bekele Na,Shifa Jz

doi:10.35248/2327-5146.7.320

Abstract

Achondroplasia is the most common form of dwarfism. Achondroplasia poses multiple anaesthetic challenges ranging from securing intravenous line, monitoring and drug dose calculations and airway management among others. Spinal anaesthesia is a very common method of anaesthesia in Botswana. The only type of anaesthetic drug that is in use for spinal anaesthesia in Botswana is hyper baric bupivacaine 0.5%. We report a case of a 33-year-old achondroplastic dwarf patient who developed bilateral visual loss for three days after he had received spinal anaesthesia for appendectomy. Postoperatively the patient was found to have increased intracranial pressure on magnetic resonance imaging scan. Subsequently decompressive ventriculo-peritoneal shunt operation was done and he gradually regained his vision. Meticulous and detailed pre anaesthetic assessment, well planned mode of anaesthesia and post-operative care of dwarf patients is essential to minimize complications and its severity. Post-operative signs and symptoms that may indicate any neurological effect of high intracranial pressure on dwarf patients have to be promptly identified and treated urgently to reduce further damage.

Highlights

Achondroplastic dwarfism is the commonest form of skeletal dysplasia
It poses multiple anaesthetic challenges ranging from securing intravenous line, monitoring and drug dose calculations to airway, spine thoracic cage, cardiopulmonary and neurological symptoms
This is supported by the fact that hydrocephalous and increased intracranial pressure related to the hydrocephalous is a common complication of Dwarf patients as shown in a study by Erdinçler et al [11]

Summary

INTRODUCTION

Achondroplastic dwarfism is the commonest form of skeletal dysplasia. It involves multiple organ system defects which can lead to anaesthetic challenge. Postoperative visual loss (POVL) is a rare complication of anaesthesia, with increased prevalence after cardiac, spine, head and neck, and some orthopaedic procedures. The most common causes of permanent POVL are central retinal artery occlusion, ischemic optic neuropathy, and cerebral vision loss [1]. In 2015 there was a rare complication published of transient bilateral hearing loss of a patient for three days after spinal anaesthesia for which the cause was not clearly established [5]. The blood pressure, pulse rate and oxygen saturation were all within normal limits throughout surgery Eight hours post operation the patient noticed that he had lost his vision He was reviewed by anaesthetist and ophthalmologist. Repeat MRI after surgery showed the catheter in situ and drainage of the accumulated CSF from the ventricles (Figure 2)

DISCUSSION

CONCLUSION