کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
2757563 1567515 2015 8 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی بیهوشی و پزشکی درد
پیش نمایش صفحه اول مقاله
Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series
چکیده انگلیسی


• Epidural analgesia may attenuate autonomic hyperreflexia but does not eliminate risk.
• Successful neuraxial anesthesia and analgesia may be more complicated, likely because of the high rate of Harrington rods in the spinal cord injury population.
• Postpartum episodes of autonomic hyperreflexia may occur in women with a history of autonomic hyperreflexia.

With improvements in management and rehabilitation, more women with spinal cord injury are conceiving children. Physiologic manifestations of spinal cord injury can complicate anesthetic management during labor and delivery. Patients who delivered at Mayo Clinic, Rochester, Minnesota between January 1, 2001 and May 31, 2012 with a history of traumatic spinal cord injury were identified via electronic record search of all parturients. Eight patients undergoing nine deliveries were identified. Six deliveries (67%) among five patients (63%) involved a trial of labor. Among these deliveries, three (50%) occurred vaginally, all with successful epidural analgesia. Trial of labor failed in the remaining three patients, and required cesarean delivery facilitated via epidural (n=1), spinal (n=1) and general anesthesia (n=1). Three patients (33%) underwent scheduled cesarean delivery via epidural (n=1), spinal (n=1), and general anesthesia (n=1). Four patients having five deliveries had a history of autonomic hyperreflexia before pregnancy. One patient had symptoms during pregnancy, two patients had episodes during labor and delivery, and three patients described symptoms in the immediate postpartum period. These symptoms were not reported by any patient without a history of autonomic hyperreflexia. Neuraxial labor analgesia may have a higher failure rate in patients with spinal cord injury, possibly related to the presence of Harrington rods. Postpartum exacerbations of autonomic hyperreflexia are common in patients with a history of the disorder.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: International Journal of Obstetric Anesthesia - Volume 24, Issue 1, February 2015, Pages 77–84
نویسندگان
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