Spinal anaesthesia for Caesarean section in a patient with systemic sclerosis

Bailey, A.R.; Wolmarans, Morné; Rhodes, S.

doi:10.1046/j.1365-2044.1999.00751.x

Cited by 19 publications

(10 citation statements)

References 23 publications

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“…Limited to case reports reporting on either epidural or single episodes of spinal anaesthesia without any form of anticoagulation, we identified 21 such reports (12 epidurals, nine spinal anaesthesia) at platelet counts <100 × 10 9 /l at the time of puncture or catheter removal (Bailey et al , 1999; Moen et al , 2004; Nguyen et al , 2006; Morisaki et al , 1995; Gustafsson et al , 1988; Chang et al , 2003; Ezri et al , 2002; Harnett et al , 2000; Hew‐Wing et al , 1989; Kuczkowski & Benumof, 2002; Landau et al , 2003; Moeller‐Bertram et al , 2004; Nafiu et al , 2004; Ozgen et al , 2004; Raft et al , 2005; Sibai et al , 1986; Steer, 1993; Tamakawa & Ogawa, 1998; Wulf et al , 1988; Yuen et al , 1999). Sixteen were for analgesia during delivery (Bailey et al , 1999; Nguyen et al , 2006; Moen et al , 2004; Chang et al , 2003; Ezri et al , 2002; Harnett et al , 2000; Hew‐Wing et al , 1989; Kuczkowski & Benumof, 2002; Landau et al , 2003; Moeller‐Bertram et al , 2004; Nafiu et al , 2004; Raft et al , 2005; Steer, 1993; Yuen et al , 1999; Sibai et al , 1986). Five of these 16 were complicated by a spinal haematoma (three patients with HELLP syndrome, one patient with pre‐eclampsia and one patient with coagulopathy following resuscitation for haemorrhagic shock) (Yuen et al , 1999; Moen et al , 2004; Nguyen et al , 2006; Sibai et al , 1986) and one by an intracranial subdural haematoma in a patient with HELLP syndrome (Ezri et al , 2002).…”

Section: Case Reports In Regional Anaesthesiamentioning

confidence: 99%

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

2009

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Summary Neuraxial anaesthesia is increasingly performed in thrombocytopenic patients at the time of delivery of pregnancy. There is a lack of data regarding the optimum platelet count at which spinal procedures can be safely performed. Reports are often confounded by the presence of other risk factors for spinal haematomata, such as anticoagulants, antiplatelet agents and other acquired or congenital coagulopathies/platelet function defects or rapidly falling platelet counts. In the absence of these additional risk factors, a platelet count of 80 × 109/l is a ‘safe’ count for placing an epidural or spinal anaesthetic and 40 × 109/l is a ‘safe’ count for lumbar puncture. It is likely that lower platelet counts may also be safe but there is insufficient published evidence to make recommendations for lower levels at this stage. For patients with platelet counts of 50–80 × 109/l requiring epidural or spinal anaesthesia and patients with a platelet count 20–40 × 109/l requiring a lumbar puncture, an individual decision based on assessment of risks and benefits should be made.

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Section: Case Reports In Regional Anaesthesiamentioning

confidence: 99%

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

2009

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“…We have included 136 reports, both full publications and abstracts, covering 158 cases (see also Supporting Information, Appendices S1–S6) . Case reports largely fall into two groups: those describing equipment, or a technique, for provision of general anaesthesia; or those identifying a woman who had predicted airway difficulty, who was managed with regional analgesia or anaesthesia with the aim of avoiding of general anaesthesia.…”

Section: Resultsmentioning

confidence: 99%

“…Of note, 22 women with fixed or chronic conditions that involved airway risks were only identified by the anaesthetic service at short notice before surgery, rendering advanced planning impossible .…”

Section: Resultsmentioning

confidence: 99%

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

2020

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We reviewed the literature on management of general and regional anaesthesia in pregnant women with anticipated airway difficulty. We identified 138 publications comprising 158 cases; these either described equipment or techniques for the provision of general anaesthesia, or the management of women with regional analgesia or anaesthesia, with the aim of avoiding general anaesthesia. Most of the former group described women requiring caesarean section alone, or in combination with other surgery, which was sometimes airwayrelated. Management techniques were largely similar to those in non-obstetric patients requiring surgery who have airway difficulties, although suggested differences related to physiological changes of pregnancy and avoidance of nasal intubation. In the reports discussing regional anaesthesia, consideration was often given to the possible requirement for urgent out-of-hours anaesthetic intervention, and the predicted difficulty of management of general anaesthesia should it be required. In a number of reported cases, multidisciplinary planning led to the conclusion that elective caesarean section should be performed in order to avoid emergency airway management. Based on this literature review, we advise antenatal planning that includes: assessment of the patient's clinical characteristics; consideration of the equipment and personnel available to provide safe airway management out-of-hours; and elective caesarean section should these be lacking. If general anaesthesia is required, a risk assessment must be made as to the probability of safe airway management after the induction of anaesthesia, and awake tracheal intubation should be used if this cannot be assured. Decision aids are provided to illustrate these points. Online appendices include a comprehensive compendium of case reports on the management of a number of rare syndromes and airway conditions.

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“…We chose general anesthesia for the patient, due to of positioning difficulty while he was awake and for the concern of prolonged duration of the local anesthetics (Bailey et al 1999). In addition, because of some severe complications during regional anesthesia, patients may require endotracheal intubation which is always difficult and emergent.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a patient with localised scleroderma

Kong

Huang

2016

SpringerPlus

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IntroductionScleroderma is a progressive fibrotic disorder of connective tissue which can present multiple anesthetic challenges to anesthetists, especially airway management. Awake intubation with fiberoptic bronchoscope is widely accepted and implemented for progressive systematic scleroderma patients. With the development and improvement of intubation devices these years, there is no report addressing other intubation methods for sclerotic patients.Case descriptionA 47 year-old, 42-kg man with 1-year history of localized scleroderma was scheduled for the operation of inner fixation after 6 days of his acetabular fracture. With careful pre-anesthesia assessment, we chose general anesthesia and intubated the patient with Shikani optical stylet under rapid sequence introduction successfully.DiscussionScleroderma is a multisystem disease that can affect every aspect of anesthesia especially airway management, which can pose a significant challenge for anesthesiologists. As a result, understanding its pathophysiological changes and implementing a meticulous pre-anesthesia check-up are essential when making an anesthetic plan.ConclusionAnesthetists should have a thorough consideration of all the patho-physiological changes in patients with scleroderma, so as to make a full preparation peri-operatively. Shikani optical stylet may become an alternation for difficult airway in patients with scleroderma.

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Spinal anaesthesia for Caesarean section in a patient with systemic sclerosis

Cited by 19 publications

References 23 publications

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

Anesthetic management of a patient with localised scleroderma

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