A Combined Spinal Epidural Anesthetic (CSE) for Cesarean Section in a Patient with Achondroplasia. Can MRI be Helpful?

The anatomic features of achondroplastic patients pose many challenges for anesthesiologists. The achondroplastic parturient has a high likelihood of delivery by cesarean section due to cephalopelvic disproportion. Hence, anesthesiologist involvement is crucial. It is not uncommon for these patients to have a narrow spinal canal and areas of spinal stenosis. These features might prove a challenge for a neuraxial technique and potentially result in unpredictable spread of local anesthetic. We present a case in which an abnormal Magnetic Resonance Imaging (MRI) was used to tailor the anesthetic plan for an achondroplastic parturient and possibly explain some of our intraoperative observations.