Bilateral loss of vision after spinal anaesthesia on a dwarf patient

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.