Spina bifida and epidural anaesthesia
•Download as PPT, PDF•
6 likes•7,706 views
![Case Report ,[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Spina bifida and epidural anaesthesia
Similar to Spina bifida and epidural anaesthesia (20)
More from Wahid altaf Sheeba hakak
More from Wahid altaf Sheeba hakak (8)
Recently uploaded
Recently uploaded (20)
Spina bifida and epidural anaesthesia
- 1. Dr Wahid altaf. Dr Gabriella Iohom. Cork University Hospital.
- 12. Spina bifida.
Editor's Notes
- Myeloschisis or myeolocele : Myelomeningocele : Most common form, Cystic swelling lined by dura and arachnoid, protruding though a defect in the vertebral arches, Spinal cord & nerve roots are carried out into the fundus of the sac, The terms Spina Bifida and Myelomeningocele are often used interchangeably. most severe form, deficiency of vertebral arches, neural plate material spread out on the surface, in a shallow depression or over a cystic swelling of the meninges. Meningocele : Cystic swelling of dura and arachnoid protruding though a defect in the vertebral arches. The spinal cord is entirely confined within the vertebral arches but may show abnormalities.
- With constant improvements in medical and surgical care, and subsequent decreases in spina bifida-related mortality and morbidity many women with these defects are reaching childbearing age. There may be no external lesion, in spina bifida occulta and the overlaying skin usually remains intact, it is not associated with any neurological symptoms and is often an incidental radiological finding.
- The use of continuous epidural, caudal, and spinal analgesia, paravertebral sympathetic and paracervical blocks, and intravenous patient-controlled analgesia have been reported in pregnant women with spina bifida, however, all of these techniques have been associated with number of limitations, and complications.
- Most common site for spina bifida occulta lesion is L5 S1 vertebral level which is below the level of spinal or epidural block. Spinal and epidural techniques are usually uncomplicated. However, it is recommended that the block be performed above the level of the lesion. It is also important that the possibility of patchy or higher blockade than normal in these parturients be kept in mind
- Vaagenes and Fjaerestad described a parturient with lumbosacral meningocele (status post corrective surgery in the neonatal period) who received a lumbar epidural analgesia for pain relief in labour. Although a high intervertebral level was chosen for the epidural needle placement, deficiency of the dorsal interspinous layer of ligaments complicated the localization of the epidural space (loss of resistance technique was used). The authors noted that analgesia was accomplished very rapidly and with a lower dose of analgesic than is usually required in healthy parturients.
- Tidmarsh and May conducted a retrospective chart review study of the anaesthetic management during labour of 16 patients with spina bifida who delivered at their tertiary care centre between March 1994 and February 1996. Of these 16 patients, 10 received an epidural analgesia for labour. Of the 10 epidurals, six resulted in symmetrical sensory block. In each case the sensory block did not extend above T10. Of the remaining four epidurals there was one dural puncture, one asymmetric block, one excessively high block, and one failure of the block to extend below the level of the spinal defect. The authors concluded that the conduct of epidural analgesia in patients with spina bifida can be technically difficult, and results often unpredictable (e.g., excessive cranial/poor perineal spread of local anaesthetics, and/or asymmetric block) .
- The authors conSuelto and Shaw reported on the use of paravertebral lumbar sympathetic block (LSB) for labour analgesia (in the first stage of labour) in two parturients with spina bifidacluded that LSB should be considered in pregnant women with spina bifida where epidural analgesia may be precluded, however, cautioned about the limitations of LSB for labour analgesia. These limitations include short duration of action, and absence of continuous labour analgesia, and thus the subsequent need for a second anaesthetic during the second stage of labour . Other concerns associated with LSB in parturients are increased pain during placement of the block when compared to epidural anaesthesia, and maternal hypotension.
- d/d of pdph : Pre eclampsia Tention headache Migraine Subdural haematoma Cerebral vein thrombosis Sah Meningitis Cerebral tumour Anxiety and depression Hypoglycemia Electrolyte imbalance. 70% success rate after blood patch. Repeat dural blood patch at 18 hours if needed. Analgesics NSAIDS/OPIOIDS AS NEEDED. Caffeine sod.benzoate 500mg in 1 lt of NS infused over 1 hour. 300 mg oral caffeine. Theophylline/sumatryptan. Initially 3 to 8 ml of blood used but now 15 ml to 20 ml. If blood patch done prophylactically only 10% develop headache. Saline patch 40 ml saline followed by 40ml/hr infusion for 12 hrs-24 hrs or 20 ml-30 ml dextran . Effective for short term but pdph recurs once infusion stopped. Complications of dural patch: Redo puncture 35% report back pain Neck pain/leg pain/parasthesia/radiculitis/fever/temorary cranial nerve palsies. Blood patch effective in 95% times.