Authors: Dumitrascu, Catalina I. et al.
Anesthesia & Analgesia 141(4):779–792, October 2025. DOI: 10.1213/ANE.0000000000007397
This narrative review examined the anesthetic management of parturients with achondroplasia—who represent roughly 70% of all forms of dwarfism—during labor and cesarean delivery. Given the high rate of cesarean births due to cephalopelvic disproportion and the known airway and spinal anatomical challenges in these patients, the study sought to identify optimal anesthesia techniques through an analysis of case reports and series published through January 2024.
Across 57 manuscripts describing 80 anesthetic cases, management approaches included spinal (28 cases), epidural (17), combined spinal-epidural (12), general anesthesia (16), and intrathecal catheter (1). Six patients required conversion to general anesthesia—most often for failed neuraxial attempts or inadequate block. Reduced intrathecal doses of local anesthetic, particularly bupivacaine, were frequently employed to mitigate risks of high spinal blockade. Reported complications included hypotension (4/64), transient paresthesia (3/64), and inadvertent dural puncture (1/64), all of which were infrequent and manageable.
The authors conclude that neuraxial anesthesia, when carefully titrated and individualized, is feasible and preferred for most parturients with achondroplasia. The combined spinal-epidural approach allows dose adjustment and gradual block height control, reducing the risks of hemodynamic instability and airway complications inherent to general anesthesia in this population.
What You Should Know
• Achondroplastic parturients frequently require cesarean delivery due to cephalopelvic disproportion.
• Neuraxial anesthesia—especially combined spinal-epidural—is generally safe and effective when dosed conservatively.
• General anesthesia remains an alternative but carries higher airway and hemodynamic risks.
• Preoperative imaging and multidisciplinary planning are essential for safe management.
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