Central Regional Anaesthesia in a Patient with Klippel-Trenaunay Syndrome

Christie, I.; Ahkine, P. A.; Holland, R. L.

doi:10.1177/0310057x9802600318

Cited by 12 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar to the findings in these previous reports [12,19,20], an MRI study of the present patient's spine demonstrated the absence of neurovascular abnormalities, thereby suggesting that major conduction anesthesia was a feasible option in this patient with an anticipated difficult airway. However, unlike the previously described patients [12,[18][19][20], KasabachMerritt syndrome was also observed in the present patient.…”

Section: Discussionsupporting

confidence: 90%

“…However, unlike the previously described patients [12,[18][19][20], KasabachMerritt syndrome was also observed in the present patient. Thus, the use of a neuraxial anesthetic technique may have been relatively contraindicated if the coagulation defects had not been substantially corrected before surgery.…”

Section: Discussioncontrasting

confidence: 89%

“…Dobbs et al [19] reported the use of epidural analgesia in a laboring parturient with KlippelTrénaunay syndrome in whom serial MRI scans had been performed in the months before the induction of labor. Further, Christie et al [20] described the use of combined spinal-epidural in a Klippel-Trénaunay patient undergoing reconstructive lower extremity surgery after a contrastenhanced CT scan excluded hemangiomatous disease and major arterial-venous malformations within the lumbosacral spine.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Successful use of spinal anesthesia in a patient with severe Klippel–Trénaunay syndrome associated with upper airway abnormalities and chronic Kasabach–Merritt coagulopathy

Holak

Pagel

2010

J Anesth

View full text Add to dashboard Cite

Klippel-Trénaunay syndrome is a rare disorder characterized by the triad of capillary or cavernous hemangiomas, venous varicosities or malformations, and soft tissue or bone hypertrophy. Neuraxial anesthesia in patients with Klippel-Trénaunay syndrome has been infrequently described and has not been previously reported when accompanied by consumptive coagulopathy with thrombocytopenia (Kasabach-Merritt syndrome). The authors describe their clinical management of a 23 year-old woman with Klippel-Trénaunay syndrome who presented for elective total knee arthroplasty. Her past medical history was notable for chronic Kasabach-Merritt syndrome, hypersplenism with pancytopenia, and intermittent lower gastrointestinal bleeding resulting from colonic hemangiomas. The physical examination revealed several large cavernous hemangiomas located on her right face, neck, chest, arm, and leg. No hemangiomas were noted within the dermatomal levels innervated by the upper lumbar spine. The neck hemangioma was very large and filled with blood when the patient assumed a supine position, making it almost impossible for her to breathe. The oropharynx revealed markedly hypertrophied soft tissue, pharyngeal, and hypopharyngeal hemangiomas, and a Mallampati class IV airway. Spinal and epidural hemangiomas were excluded based on a magnetic resonance imaging study before surgery. Kasabach-Merritt coagulopathy was corrected preoperatively by administration of cryoprecipitate. These interventions allowed the authors to safely perform a spinal anesthetic for the operation. The current case illustrates that major conduction anesthesia may be safely performed in patients with Klippel-Trénaunay disease provided that preoperative imaging studies exclude neurovascular involvement and coexisting coagulopathy is appropriately corrected.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Successful use of spinal anesthesia in a patient with severe Klippel–Trénaunay syndrome associated with upper airway abnormalities and chronic Kasabach–Merritt coagulopathy

Holak

Pagel

2010

J Anesth

View full text Add to dashboard Cite

show abstract

“…It has been stated that neuraxial anaesthesia should be avoided if MRI is not accessible 23,24 . Uneventful spinal and epidural anaesthetic procedures have been reported repeatedly in both obstetric and non‐obstetric procedures, whereas in some of them, the disease was not present at the puncturing level 21–29 . After the removal of a neuraxial catheter, the neurologic status should be followed in these patients with particular vigilance in order to detect any signs of a possible epidural haematoma.…”

Section: Spinal Congenital Anomaliesmentioning

confidence: 99%

Neuraxial techniques in patients with pre‐existing back impairment or prior spine interventions: a topical review with special reference to obstetrics

Vercauteren

Waets

Pitkänen

et al. 2011

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Many anaesthetists consider neurological disorders of all kinds as a contraindication for regional anaesthesia particularly for neuraxial techniques. This hesitation is partly rooted in fears of medicolegal problems but also in the heterogeneous literature. Therefore, the present topical review is an attempt to describe the feasibility and the risks of neuraxial techniques in patients with spinal injury, anatomical compromise, chronic back pain or previous spinal interventions, ranging from 'minor' types like epidural blood patches to major surgery such as Harrington fusions. Most reviews and case reports were describing experiences in obstetrics as these patients are more likely to insist on neuraxial blocks. In the acute phase of new neurologic injury, general anaesthesia may be the technique of choice to prevent further haemodynamic and respiratory deterioration. After the acute phase, current evidence is mostly reassuring with respect to the risks of neuraxial blocks as they may even be recommendable in some conditions. Ultrasound technology may be of additional help to increase the success rate. A careful pre-operative examination remains mandatory, while patients should be sufficiently informed about technical aspects and possible relapses or progression of their disease. When necessary, patients should have additional technical and clinical examinations as close as possible to surgery to establish the actual pre-operative status. Most patients may benefit more from spinal techniques rather than from less reliable epidural ones. High concentrations and volumes of local anaesthetics should be avoided at all times, especially in patients with nerve compression, large disc herniation or spinal stenosis.

show abstract

“…This will not only help determine the route of delivery, but the type of analgesia and anesthesia possible. Unrecog- nized vascular malformations may produce spinal hematomas, neurologic injury, and bleeding diathesis (40,45,46) during administration of regional anesthesia.…”

Section: Intrapartum Carementioning

confidence: 99%