Spinal anaesthesia for Caesarean section in a patient with a cervical arteriovenous malformation

Ong, B. Y.; Littleford, Judith; Segstro, R.; Paetkau, Don; Sutton, I. R.

doi:10.1007/bf03011908

Cited by 20 publications

(19 citation statements)

References 17 publications

(2 reference statements)

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“…Rapid epidural administration of large volumes of drug should be avoided to avoid increase in increased ICP. [3738]…”

Section: Parturient With Brain Tumormentioning

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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“…Rapid epidural administration of large volumes of drug should be avoided to avoid increase in increased ICP. [3738]…”

Section: Parturient With Brain Tumormentioning

confidence: 99%

Anesthetic management for parturients with neurological disorders

El-Refai

2013

Anesth Essays Res

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“…37 Therefore, much attention is focused on avoiding the increases in venous pressure which occur with uterine contractions and valsalva maneuvres. 39 …”

Section: Cerebral Avmsmentioning

confidence: 99%

“…52 It has been suggested that even distant SAVMs may cause a change in venous drainage locally at the site of injection, thus altering the A-V gradient. 39 Conversely, some argue that the increase in pressure following epidural injection is only transient, and in the rare situation of a patient who has sustained a spinal injury from a distant SAVM bleed, there may even be some benefits of an epidural in managing autonomic hyperreflexia perioperatively, thus avoiding the need to use suxamethonium with the risk of associated hyperkalemia. 37 The successful management of a patient with a cervical SAVM undergoing Cesarean delivery using spinal anesthesia has been described.…”

Section: Respiratory Systemmentioning

confidence: 99%

“…37 The successful management of a patient with a cervical SAVM undergoing Cesarean delivery using spinal anesthesia has been described. 39 This technique avoids the risk of hemodynamic instability associated with airway manipulation under general anesthesia where spinal cord perfusion is already vulnerable. 52 However, the associated risk of marked hypotension with regional anesthesia can result in increased venous pressure from vomiting.…”

Section: Respiratory Systemmentioning

confidence: 99%

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Anesthetic implications for the parturient with hereditary hemorrhagic telangiectasia

Lomax

Edgcombe

2009

Can J Anesth/J Can Anesth

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Purpose To review the effects of hereditary hemorrhagic telangiectasia (HHT) in the parturient and the anesthetic management of such patients during pregnancy and delivery. Source A literature search was performed using Medline and EMBASE databases. Bibliographies of retrieved articles were searched for additional sources. Principal findings Hereditary hemorrhagic telangiectasia affects 1 in 5000-8000 people. It is a genetic condition in which vascular dysplasia affects many organs particularly the pulmonary, cerebral, gastrointestinal, and spinal vasculature. A large proportion of women with HHT have uneventful pregnancies. However, women can present in pregnancy with clinically silent but potentially life-threatening features of the disorder including fatal hemorrhage from ruptured arteriovenous malformations (AVMs), systemic emboli, and high output cardiac failure secondary to arteriovenous shunting. Literature on the anesthetic management of HHT in pregnancy is limited. Both general and regional anesthetic techniques have been successfully performed in these patients, but are reliant on identifying the presence of specific AVMs; avoidance of cardiovascular instability; and prophylaxis against systemic emboli secondary to pulmonary AVM shunting. The presence of spinal AVMs is considered a relative contraindication to regional techniques. As with other systemic AVMs, these can develop and increase in size during pregnancy with implications for the timing of screening and surveillance. Conclusions An understanding of the presence and potential development of life-threatening AVMs during pregnancy is imperative for anesthesiologists caring for parturients with HHT. Even in the asymptomatic patient, a high index of suspicion should be maintained, screening performed where possible and anesthetic technique adapted accordingly. RésuméObjectif Passer en revue les effets de la te´langiectasie he´morragique he´re´ditaire (THH) chez les parturientes et la prise en charge de telles patientes pendant leur grossesse et l'accouchement. Source Une recherche de la litte´rature

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“…Ong et al (2) suggests that spinal anesthesia can be done for patients with arteriovenous malformation. The experience of others, and our own recent case, suggest that neuraxial anesthesia should be considered contraindicated in the presence of an AVM.…”

Section: Spinal Subdural Hematoma: a Pre-eclamptic Patient With A Spimentioning

confidence: 99%

An Unusual Cause of a “Missing Tip” in An Arrow® Flextip Plus® Epidural Catheter

Warzynski

Au-Truong

Joseph

2006

Anesthesia & Analgesia

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Spinal anaesthesia for Caesarean section in a patient with a cervical arteriovenous malformation

Abstract: The safe outcome of spinal anaesthesia for our patient is encouraging. The presence of spinal cord AVM at the cervical region is not an absolute contraindication to spinal anaesthesia.

Cited by 20 publications

References 17 publications

Anesthetic management for parturients with neurological disorders

Anesthetic management for parturients with neurological disorders

Anesthetic implications for the parturient with hereditary hemorrhagic telangiectasia

An Unusual Cause of a “Missing Tip” in An Arrow® Flextip Plus® Epidural Catheter

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