Local infiltration anesthesia combined with S-ketamine for cesarean delivery in a parturient with diaphragmatic hernia and severe scoliosis: a case report

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. 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. 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.