BACKGROUND: Combined spinal-epidural anesthesia (CSEA) has gained an increasing interest as it combines the reliability of a spinal block and the flexibility of an epidural block. This study was designed to determine the distance from skin to epidural space (S-EP) and the distance from epidural space to subarachnoid space (E-SA) in obstetric parturient and whether weight, height, BMI (body mass index) and PI (ponderal index) might influence S-EP and E-SA. METHODS: Sixty obstetric patients undergoing elective cesarean section during CSEA in L3-4 level were partitioned into group I (with dural click), group II (no dural click) and in each group, weight (prepregnancy, pregnancy), height, BMI and PI were measured. Measurements of S-EP and E-SA were made. The Pearson correlation was used to investigate relationships between S-EP, E-SA and patient characteristics (height, weight, BMI, PI). RESULTS: S-EP was 4.39+/-0.49 cm and E-SA was 8.23+/-2.05 mm (7.99+/-2.07 mm in group I, 8.78+/-1.94 mm in group II). S-EP was related to weight, BMI and PI except height. E-SA was related to pregnancy BMI and pregnancy PI in group I. No correlation was found between E-SA and other variables in group II. CONCLUSIONS: E-SA in obstetric parturients was related to obesity and has been found to be somewhat larger and more variable due to the segmented and discontinous nature of epidural space.
Anesthesia* ; Cesarean Section* ; Epidural Space* ; Female ; Humans ; Obesity ; Pliability ; Pregnancy ; Skin ; Subarachnoid Space*

Eisenmenger's syndrome includes any condition in which communication between the pulmonary and systemic circulations gives rise to pulmonary vascular disease causing a right to left shunt with peripheral cynosis. The theoretical risks of anesthesia in patients with Eisenmenger's syndrome are considerable. We report on the case of a 47-year-old female patient with Eisenmenger's syndrome secondary to ventricular septal defect for transabdominal hysterectomy. Of prime concern was the maintenance of sytemic vascular resistance, and this was achieved using an infusion of phenylephrine started before the induction of anesthesia; the infusion continued after the operation. We carefully performed general anesthesia with N2O-O2-ketamine-fetanyl-enflurane. The patient was discharged for home 8 days later without complications.
Anesthesia ; Anesthesia, General ; Eisenmenger Complex* ; Female ; Heart Septal Defects, Ventricular ; Humans ; Hysterectomy ; Middle Aged ; Phenylephrine ; Vascular Diseases ; Vascular Resistance