A 40-year-old woman scheduled for elective laparoscopic cholecystectomy prefers neuraxial anaesthesia. Screening reveals each of the following findings. Which one constitutes an ABSOLUTE contraindication to spinal anaesthesia?
- A Previous uncomplicated lumbar laminectomy
- B Chronic tension-type headache
- C Deranged coagulation profile with INR 1.9 and platelet count 55 x 10^9/L ✓
- D Stable peripheral diabetic neuropathy affecting the feet
Correct answer: C. Deranged coagulation profile with INR 1.9 and platelet count 55 x 10^9/L
Explanation
Coagulopathy of this severity carries a real risk of spinal epidural haematoma and cord compression, making it an absolute contraindication along with patient refusal, infection at the puncture site, severe hypovolaemia and raised intracranial pressure. Previous lumbar surgery makes the technique technically harder but is a relative contraindication. Chronic headache and stable distal neuropathy are not contraindications, although neuropathy requires documentation of any pre-existing deficit before the block.
Reference: Miller's Anesthesia, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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