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Tag: anesthesia|article link

[Risk management in epidural anesthesia].

By wp_zaman

[Risk management in epidural anesthesia].

Masui. 2011 Nov;60(11):1259-66

Authors: Imamachi N, Saito Y

Abstract
Epidural anesthesia has many advantages, including block of surgical stress, postoperative pain management and prevention of postoperative complications. Therefore, we should use epidural anesthesia when indicated. However, patients with preexisting spinal stenosis or lumbar radiculopathy have higher incidence of neurologic complications after epidural anesthesia. Epidural abscesses caused by epidural anesthesia are rare. However, epidural abscesses are serious complications in patients. Knowing the risk factor of epidural abscesses is important to prevent epidural abscesses, and early diagnosis and early treatment are needed when suspected. It is important to have measures for safety in performing epidural anesthesia at every hospital. Recently, we have many anesthetic techniques, including epidural anesthesia, remifentanil infusion, ultrasound-guided peripheral nerve blocks and intravenous PCA. Therefore, we should choose an anesthesia method based on the careful evaluation of the benefit and risk balance for the patient’s safety to reduce the incidence of complications.

PMID: 22175165 [PubMed – indexed for MEDLINE]

Epidural anesthesia for Cesarean delivery in a patient with post-traumatic cervical syringomyelia.

By wp_zaman

Epidural anesthesia for Cesarean delivery in a patient with post-traumatic cervical syringomyelia.

Can J Anaesth. 2011 Aug;58(8):764-768

Authors: Margarido C, Mikhael R, Salman A, Balki M

PURPOSE: To illustrate the successful management of a patient with post-traumatic syringomyelia (PTS) and chronic pain syndrome who presented for elective Cesarean delivery under epidural anesthesia. CLINICAL FINDINGS: A 30-yr-old gravida 3 para 1 woman, with a known diagnosis of cervical PTS secondary to a whiplash injury sustained three years earlier, presented to the labour and delivery unit at 31 weeks’ gestation. She had severe pain in the cervical and lumbar spine, motor and sensory deficits in the upper extremities, tender mass in her left trapezius muscle, and history of dizziness and syncopal episodes. She was taking oxycodone 120 mg·day(-1) Magnetic resonance imaging of her spine revealed a syrinx of 2 mm in diameter extending from C4 to T1 levels with disc protrusions in the C4-C6 region. There was no evidence of Arnold-Chiari malformation or elevated intracranial pressure. On airway examination, her Mallampati score appeared normal, but there was a limitation in the range of her neck movements in all directions. An elective Cesarean delivery was planned at 39 weeks’ gestation. An epidural catheter was placed using ultrasound guidance, and the procedure was performed without complications. CONCLUSIONS: The successful management of this case suggests that epidural can be considered in women with cervical PTS presenting for a Cesarean delivery.

PMID: 21625969 [PubMed – as supplied by publisher]