Subarachnoid Blockade For Cesarean Section In A Patient With Ventriculoperitoneal Shunt. Case Report

Goulart, Alexandre Palmeira; Moro, Eduardo Toshiyuki; Rios, Rosmani de Paula; Pires, Ricardo Tadeu Faria

doi:10.1590/s0034-70942009000400009

Cited by 11 publications

(4 citation statements)

References 5 publications

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“…There is a number of case reports about anesthetic consideration in a pregnant woman with a VPS, both general and neuraxial anesthesia have been reported any complication directly associated with the anesthetic procedure [1][2][3][4][5]. To the best of our knowledge, a pregnant woman with a VPS was applied combined spinal-epidural anesthesia (CSEA) for cesarean section (C/S) has not been reported previously.…”

Section: Letter To Editor Letter To Editormentioning

confidence: 99%

Untitled

2017

JACCOA

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Submit Manuscript | http://medcraveonline.com heart rate, and SpO 2 were 124/67 mmHg, 92 per min, and 98%, respectively. After intravenous access was obtained, 15 ml/kg of crystalloid infusion was started rapidly and 2 g of cefazolin was injected for antibiotic prophylaxis. 4 L/min of oxygen was administered via a nasal cannula. With the patient in the sitting position, full aseptic precautions were taken. CSEA using 2 ml of 0.5% isobaric bupivacaine intraspinally was applied in the midline at the L3-4 interspace. Five minutes later, the sensory block had reached the T4 dermatome and surgery was started. A 2770 g healthy girl baby was delivered. Any perioperative complications were not observed. When the sensory block was declined T10 dermatome at approximately 2 hours postoperatively, analgesia was obtained via epidural catheter with 15 ml of solution, including 3 mg morphine, 50 μg fentanyl and 0.9% NaCl. The patient was observed for 48 hours with normal neurologic and vital status without pain and discharged home on postoperative day 2. When the patient was come back to Obstetrics department for control evaluation, any complaints associated with dural puncture headache or infection were not seen.In patients with a VPS, CSEA has increased the risk of infectious complications [1]. If a CSEA is planned, strict aseptic techniques and antimicrobial prophylaxis should be complied with [1]. Therefore, CSEA was applied in our patient under the antibiotic prophylaxis and strict aseptic condition. Our aim of using CSEA was rapidly reaching to appropriate level and quality of block with spinal block, and prolonged postoperative analgesia with epidural block. Besides, general anesthesia was avoided because of encountering with the risk of the difficult airway and gastric content aspiration in a fasting patient.Consequently, if strict sterile condition and antibiotic prophylaxis are provided, CSEA can be applied as an effective and safe anesthetic method for emergency C/S in a patient with a VPS.

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Section: Letter To Editor Letter To Editormentioning

confidence: 99%

Untitled

2017

JACCOA

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“…The evolution was favorable and the patient did not show any neurologic changes secondary to the technique used. [33]…”

Section: Cesarean Section In a Patient With Ventriculoperitoneal Shuntmentioning

confidence: 99%

“…A meta-analysis of eight prospective RCTs showed a higher rate of treatment failure or insufficiency with mannitol or normal saline versus HTS. [3335] Another study also found that HTS is more effective than mannitol for the treatment of elevated ICP. [36]…”

Section: Cesarean Section In a Patient With Ventriculoperitoneal Shuntmentioning

confidence: 99%

Anesthetic management for parturients with neurological disorders

El-Refai

2013

Anesth Essays Res

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Anesthesia care for the pregnant and the parturient presenting with a neurological disease requires (1) expertise with neuroanesthesia and obstetric anesthesia care, (2) accurate physical examination of the neurological system preoperatively, (3) safe choice and conductance of the anesthesia technique (mostly regional anesthesia), (4) avoidance of unfavorable drug effects for the fetus and the nervous system of the mother, and (5) intraoperative neuromonitoring together with the control of the fetal heart rate. The most important message is that in the ideal case, any woman with a known, preexisting neurological disorder should discuss her plans to become pregnant with her physician before she becomes pregnant. Neurological diseases in pregnancy can be classified into three categories: (a) Pre-existent chronic neurological diseases such as epilepsy and multiple sclerosis (MS). (b) Diseases with onset predominantly in pregnancy such as some brain tumors or cerebrovascular events. (c) Pregnancy-induced conditions such as eclampsia and Hemolysis elevated liver enzymes and low platelets syndrome. This article addresses specific issues surrounding neurologic disease in pregnant women including MS parturient, spinal cord injury, parturient with increased intracranial pressure and shunts, parturient with brain tumors, Guillain-Barré syndrome and epilepsy.

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“…Spinal anesthesia has also been described recently in a parturient with a ventriculoperitoneal shunt, as there is no contraindication for neuraxial block in this set of circumstances. 76 Physicians must bear in mind the possibility of shunt malfunction during pregnancy due mainly to uterine enlargement, 77,78 while malfunction might also occur after operative delivery, possibly due to obstruction from blood clots. 79 General anesthesia in pregnant women with IIH General anesthesia for Cesarean delivery in parturients with IIH is recommended only when absolutely necessary, since the aim of treatment lies in minimizing increases in ICP.…”

Section: Vaginal Delivery and Anesthesiamentioning

confidence: 99%