Pragmatic approach to neuraxial anesthesia in obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system

Abstract

Neuraxial anesthesia provides optimal labor analgesia and cesarean delivery anesthesia. Obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system present unique challenges to the anesthesiologist. Potential concerns include mechanical interference, patient injury and the need for imaging. Unfortunately, the existing literature regarding neuraxial anesthesia in these patients is largely limited to case series and rare retrospective studies. The lack of practice guidance may lead to unwarranted fear of patient harm and subsequent avoidance of neuraxial anesthesia for cesarean delivery or neuraxial analgesia for labor, with additional risks of exposure to general anesthesia. In this narrative review, we use available evidence to recommend a framework when considering neuraxial anesthesia for an obstetrical patient with neuraxial pathology.

Mechanism of dexmedetomidine preconditioning on spinal cord analgesia in rats with functional chronic visceral pain

“…Quantitative PCR was performed in reaction volume containing 20 μL SYBR Green PCR Master Mix. The transcript level (mean of control) was determined relative to the calibrator and normalized to the endogenous reference (2 – ΔΔCT method) 16 .…”

Real-time ultrasound-guided neuraxial anesthesia for cesarean section in parturients with previous internal fixation surgery for lumbar fracture: a case series

“…It remains unclear which anesthesia is most appropriate for CS in parturients who have undergone internal fixation surgery for lumbar fracture. Neuraxial anesthesia is not an absolute contraindication in these patients (6,7); however, postoperative distortion of the anatomy makes the block technically challenging and may increase the likelihood of failure, inadvertent dural puncture during epidural anesthesia, paresthesias, or unpredictable spread of the local anesthetic (8). Nevertheless, neuraxial anesthesia should be considered, as it offers undeniable advantages for CS.…”