British journal of anaesthesia
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We describe the successful management of a 26-yr-old achondroplastic dwarf undergoing elective Caesarean section under extradural anaesthesia. The patient had marked thoracolumbar kyphoscoliosis and clinical features which suggested that tracheal intubation would prove difficult. Block sufficient for surgery required only 5 ml of 0.5% bupivacaine and, apart from an initial unilateral block and mild intraoperative hypotension, her perioperative course was uneventful.
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The porphyrias are inherited disorders of haem metabolism, acute attacks of which may be precipitated by anaesthesia, surgery and pregnancy. The principal clinical feature of the disease is an acute neuropathy. A patient with acute intermittent porphyria was given bupivacaine as part of a regional anaesthetic for Caesarean section. The course of anaesthesia was uneventful.