Cosyntropin for Prophylaxis against Postdural Puncture Headache after Accidental Dural Puncture Department of Anesthesiolo...
Aim of Study <ul><li>Investigate the effect of administration of cosyntropin after accidental dural puncture (ADP) on the ...
Background <ul><li>Incidence of inadvertent dural tap at attempted epidural placement in obstetric patients is 0.4–6%. </l...
Cosyntrophin in PDPH <ul><li>Precise mechanism of action not known. </li></ul><ul><li>ACTH stimulates aldosterone release....
Material and Method <ul><li>95 parturients, who had epidural analgesia for normal vaginal delivery and who suffered an ina...
Technique of Epidural block <ul><li>Anaesthesiologist. </li></ul><ul><li>16 or 18 g Needle. </li></ul><ul><li>Sitting or l...
Diagnosis of post dural puncture headache <ul><li>Headache within 5 days after dural puncture, which worsened within 15 mi...
Management of acute dural puncture <ul><li>Patient admitted to hospital for 48 hrs. </li></ul><ul><li>Patient to report he...
Management of post dural puncture headache <ul><li>Conservative management for 48hrs. Fluids/NSAIDS/ Mepireden. </li></ul>...
Results
 
 
 
 
 
 
Conclusion <ul><li>Significant reduction in the incidence of PDPH and the need for EBP.  </li></ul><ul><li>Significant pro...
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Cosyntrophin for pdph

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Cosyntrophin for pdph

  1. 1. Cosyntropin for Prophylaxis against Postdural Puncture Headache after Accidental Dural Puncture Department of Anesthesiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt Anesthesiology :August 2010 Sheeba Hakak.
  2. 2. Aim of Study <ul><li>Investigate the effect of administration of cosyntropin after accidental dural puncture (ADP) on the incidence of post-dural puncture headache (PDPH) and the need for therapeutic epidural blood patch (EBP). </li></ul><ul><li>A secondary aim was to study the effect of this intervention on the severity of PDPH and the need for repeat EBP. </li></ul>
  3. 3. Background <ul><li>Incidence of inadvertent dural tap at attempted epidural placement in obstetric patients is 0.4–6%. </li></ul><ul><li>75–86% of the incidents are complicated by postdural puncture headache . </li></ul><ul><li>Associated with a significant increase in the hospital length of stay. </li></ul><ul><li>Role of prophylactic administration cosyntrophin on PDPH is unclear. </li></ul>
  4. 4. Cosyntrophin in PDPH <ul><li>Precise mechanism of action not known. </li></ul><ul><li>ACTH stimulates aldosterone release. </li></ul><ul><li>Increased CSF production. </li></ul><ul><li>ACTCH interaction with opioid receptors. </li></ul><ul><li>Specific dose .Not known. </li></ul>
  5. 5. Material and Method <ul><li>95 parturients, who had epidural analgesia for normal vaginal delivery and who suffered an inadvertent dural tap, were included in this study. </li></ul><ul><li>Exclusion criteria were contraindication to steroid or ACTH therapy ( e.g., hypertension or diabetes mellitus), preeclampsia, or contraindication to EBP (e.g., fever or leukocytosis). </li></ul>
  6. 6. Technique of Epidural block <ul><li>Anaesthesiologist. </li></ul><ul><li>16 or 18 g Needle. </li></ul><ul><li>Sitting or lying down. </li></ul><ul><li>Loss of resistance to saline. </li></ul><ul><li>Median or paramedian approach. </li></ul><ul><li>Site of block. </li></ul><ul><li>Dural Tap……… Withdraw needle and try epidural at other space. </li></ul><ul><li>Catheter threaded 3 cm into the epidural space and tested with 3 ml of 2% lidocaine with 1:200,000 epinephrine. </li></ul><ul><li>Loading dose of 8–15 ml of 0.125% bupivacaine and 50 μg of fentanyl . </li></ul><ul><li>Infusion of 0.125% bupivacaine with fentanyl 2 μg/ml at a rate of 8–15 ml/h. </li></ul>
  7. 7. Diagnosis of post dural puncture headache <ul><li>Headache within 5 days after dural puncture, which worsened within 15 min of sitting or standing, and improved within 15 min after lying, with at least one of the following criteria: neck stiffness, tinnitus, hypacusia, photophobia, or nausea. </li></ul><ul><li>Patients who did not develop PDPH for 48 h after ADP and who were ambulating normally were discharged from the hospital with the instruction to come back for reassessment if they experience any headache. </li></ul>
  8. 8. Management of acute dural puncture <ul><li>Patient admitted to hospital for 48 hrs. </li></ul><ul><li>Patient to report headache and encouraged to ambulate ,take plenty of fluids and stool softners prescribed. </li></ul><ul><li>Headache inquired every 8hrs. </li></ul>
  9. 9. Management of post dural puncture headache <ul><li>Conservative management for 48hrs. Fluids/NSAIDS/ Mepireden. </li></ul><ul><li>Epidural blood patch. </li></ul><ul><li>Redo epidural blood patch if no improvement within 24 hrs of blood patch. </li></ul><ul><li>Patients followed up for 14 days post blood patch. </li></ul>
  10. 10. Results
  11. 17. Conclusion <ul><li>Significant reduction in the incidence of PDPH and the need for EBP. </li></ul><ul><li>Significant prolongation of the time from ADP to occurrence of PDPH. </li></ul><ul><li>No influence either the duration or the severity of the headache. </li></ul><ul><li>In patients who developed PDPH, prophylactic administration of cosyntropin did not seem to influence the need of either EBP or repatching. </li></ul>

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