Perioperative Management of Alcohol Withdrawal in an Achondroplastic Dwarf with an Unstable Cervical Spine: A Difficult Management Dilemma Lauryn R. Rochlen, MD, and Robert K. Fraumann, MD, JD Patients presenting with alcohol withdrawal syndrome have an increased risk of perioperative events related to hemodynamic and respiratory instability. We present the case of a 49-year-old achondroplastic dwarf in alcohol withdrawal with cervical spinal cord injury and aortic dissection requiring emergency surgery. Due to conflicting perioperative management goals, a decision was made to delay surgery until the patient became clinically stable. Additional options might have been explored and resulted in better outcome. (A&A Case Reports 2013;1:55–7)
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t is estimated that between 10% and 20% of hospitalized patients chronically abuse alcohol, and the incidence of chronic alcohol abuse is more frequent in surgical patients due to alcohol-related trauma requiring surgical intervention.1,2 The sequelae of chronic alcoholism may also necessitate surgical care. As many as 50% of patients presenting with cancer of the gastrointestinal tract are chronic alcohol users.3 It is therefore likely that anesthesiologists will encounter patients with alcohol use–related disorders as they present for surgical or diagnostic procedures. We discuss the case of an achondroplastic dwarf with an unstable cervical spine actively withdrawing from alcohol on presentation for surgery. Written consent was obtained from the patient for publication of this case report.
CASE DESCRIPTION
A 49-year-old achondroplastic male dwarf presented with acute loss of upper and lower extremity strength. The previous evening he was intoxicated with alcohol and fell down a flight of stairs. The following morning he awoke with complete loss of lower extremity function and upper extremity extension. Magnetic resonance imaging revealed a spinal cord contusion and ligamentous injury at C4 and C5. Computed tomography showed a descending aortic arch dissection involving the innominate artery, carotid arteries, left subclavian artery, and the thoracic and abdominal aorta. He transferred to our facility for further management. Our patient’s medical history included hypertension, gastric ulcers, and significant alcohol abuse. The vascular dissections were thought to be chronic, and his systolic blood pressure was maintained
I
t is estimated that between 10% and 20% of hospitalized patients chronically abuse alcohol, and the incidence of chronic alcohol abuse is more frequent in surgical patients due to alcohol-related trauma requiring surgical intervention.1,2 The sequelae of chronic alcoholism may also necessitate surgical care. As many as 50% of patients presenting with cancer of the gastrointestinal tract are chronic alcohol users.3 It is therefore likely that anesthesiologists will encounter patients with alcohol use–related disorders as they present for surgical or diagnostic procedures. We discuss the case of an achondroplastic dwarf with an unstable cervical spine actively withdrawing from alcohol on presentation for surgery. Written consent was obtained from the patient for publication of this case report.
CASE DESCRIPTION
A 49-year-old achondroplastic male dwarf presented with acute loss of upper and lower extremity strength. The previous evening he was intoxicated with alcohol and fell down a flight of stairs. The following morning he awoke with complete loss of lower extremity function and upper extremity extension. Magnetic resonance imaging revealed a spinal cord contusion and ligamentous injury at C4 and C5. Computed tomography showed a descending aortic arch dissection involving the innominate artery, carotid arteries, left subclavian artery, and the thoracic and abdominal aorta. He transferred to our facility for further management. Our patient’s medical history included hypertension, gastric ulcers, and significant alcohol abuse. The vascular dissections were thought to be chronic, and his systolic blood pressure was maintained
