局部浸润麻醉联合S-氯胺酮用于一例合并膈疝和严重脊柱侧弯产妇的剖宫产：病例报告

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中文摘要

背景： 椎管内麻醉和全身麻醉是剖宫产的常规方法。包括超声检查和视频喉镜在内的辅助技术进一步提高了这些麻醉方法的成功率。然而，在经过仔细筛选、对标准技术存在绝对禁忌证的高危患者中，可考虑替代策略。
病例介绍： 我们报告一例妊娠女性合并膈疝和严重脊髓灰质炎相关脊柱侧弯，在所有标准麻醉方案均被判定为不可行或风险过高后，于局部浸润麻醉联合S-氯胺酮下实施剖宫产的病例。
结论： 对于全身麻醉风险过高、椎管内麻醉在技术上不可行且腹部区域阻滞无法安全实施的患者，在特殊情况下，局部浸润麻醉联合S-氯胺酮可作为最后手段的挽救策略。然而，该方法绝不应被视为既定麻醉标准的替代方案，仅适用于极少数经过仔细筛选的病例。

英文摘要

BACKGROUND: Neuraxial and general anesthesia are the conventional approaches for cesarean section. Adjunctive techniques including ultrasonography and video laryngoscopy have further improved the success rate of these anesthetic methods. However, in carefully selected high-risk patients with absolute contraindications to standard techniques, alternative strategies may be considered.
CASE PRESENTATION: We report a case of cesarean delivery performed under local infiltration anesthesia combined with S-ketamine in a pregnant woman with diaphragmatic hernia and severe poliomyelitis-related scoliosis, after all standard anesthetic options were deemed unfeasible or excessively risky.
CONCLUSION: For patients in whom general anesthesia carries prohibitively high risks, neuraxial anesthesia is technically unfeasible, and abdominal regional blocks cannot be performed safely, local infiltration anesthesia with S-ketamine may serve as a last-resort rescue strategy under exceptional circumstances. However, this approach should never be considered an alternative to established anesthetic standards and is only applicable in extremely rare, carefully selected cases.