Development of a Step-By-Step Clinical Decision Tool for Difficult Spinal Anesthetics: A Case Report of a Pregnant Patient With Achondroplasia, Previous Lumbar Fusion, and Class III Obesity

Achondroplasia is the most common bone dysplasia. Many patients have concomitant challenging neuraxial and airway anatomies. We describe a case of a G1P0 who presented for cesarean delivery due to achondroplasia, with comorbidities of Class III obesity and previous spinal fusion of unknown level. No preoperative anesthesia consultation had been requested, nor was previous neuraxial imaging available. After several failed spinal attempts with a 25-G Whitacre needle, a 22-G spinal needle was used with success. This case catalyzed our development of a clinical decision tool to algorithmically troubleshoot management of spinal anesthesia in patients with challenging neuraxial anatomy.