Neuraxial Anesthesia in Parturients with Intracranial Pathology: A Comprehensive Review and Reassessment of Risk

被引:58
|
作者
Leffert, Lisa R. [1 ,2 ]
Schwamm, Lee H. [2 ,3 ]
机构
[1] Massachusetts Gen Hosp, Dept Crit Care Anesthesia & Pain Med, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA
关键词
CHIARI-I MALFORMATION; VENOUS SINUS THROMBOSIS; LUMBAR EPIDURAL ANALGESIA; CESAREAN-SECTION; MOYAMOYA-DISEASE; SPINAL-ANESTHESIA; ARTERIOVENOUS-MALFORMATIONS; LUMBOPERITONEAL SHUNT; OBSTETRIC ANESTHESIA; DURAL PUNCTURE;
D O I
10.1097/ALN.0b013e31829374c2
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Parturients with intracranial lesions are often assumed to have increased intracranial pressure, even in the absence of clinical and radiographic signs. The risk of herniation after an inadvertent dural puncture is frequently cited as a contraindication to neuraxial anesthesia. This article reviews the relevant literature on the use of neuraxial anesthesia in parturients with known intracranial pathology, and proposes a framework and recommendations for assessing risk of neurologic deterioration, with epidural analgesia or anesthesia, or planned or inadvertent dural puncture. The authors illustrate these concepts with numerous case examples and provide guidance for the practicing anesthesiologist in determining the safety of neuraxial anesthesia.
引用
收藏
页码:703 / 718
页数:16
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