A parturient with neurofibromatosis type 2: anesthetic and obstetric considerations for delivery

Sakai, Tetsuro; Vallejo, Manuel C.; Shannon, Kelly T.

doi:10.1016/j.ijoa.2005.02.007

Cited by 25 publications

(19 citation statements)

References 11 publications

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“…Ideally, we would have coordinated with our obstetricians prior to presentation for induction of labor in order to perform a complete evaluation of this patient, including imaging of the neuraxis, with an MRI. In the antepartum setting, identifying patients at risk and conducting a thorough assessment prior to the onset of labor is essential [16]. As stated above in our case, based on the current disease definition and given that CNS involvement appears to be rare with SNF, we felt that it was safer to proceed with spinal anesthesia for our patient's urgent cesarean delivery as opposed to general anesthesia.…”

Section: Discussionmentioning

confidence: 84%

“…NF1 is known to have central nervous system involvement with neurofibromas [8]. These can lead to challenging placement of neuraxial anesthetics by creating an anatomical obstruction, or if a mass lesion is present in the brain, this could raise intracranial pressure, thus contraindicating subarachnoid penetration [16]. This risk is heightened in pregnancy as lesions tend to enlarge due to hormonal changes [3,17].…”

Section: Discussionmentioning

confidence: 99%

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Anesthetic management of a parturient with segmental neurofibromatosis

Blackney¹,

McKeen²,

Lai³

2014

J Anesthesiol Clin Sci

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Segmental neurofibromatosis is a rare, but likely under reported form of neurofibromatosis. The traditional definition is that of dermatologic manifestations of neurofibromatosis, including neurofibromas and café-au-lait macules, confined to one segment of the body as a result of a somatic mutation. However, this definition has expanded to include deeper tissue and systemic involvement. To date, there is limited description with regards to anesthetic management of obstetric patients with this condition. Here we report on a patient with segmental neurofibromatosis who presented for induction of labor that was soon complicated by conversion to cesarean delivery for a non-reassuring fetal heart rate tracing.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a parturient with segmental neurofibromatosis

Blackney¹,

McKeen²,

Lai³

2014

J Anesthesiol Clin Sci

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“…The anesthetic management of parturients with NF2 presenting for caesarean section with general anaesthesia has been reported [3]. JE Spiegel et al, have described Lumbar epidural anesthesia for caesarean delivery in a NF2 patient [4].…”

Section: Resultsmentioning

confidence: 99%

Anaesthetic Management of a Child with Neurofibromatosis Type 2 for Multiple Tumour Decompressions

Lakshiminarasimhaiah

Jagannatha

Pai

et al. 2013

JCDR

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CASE REPORTA 9-year-old girl presented with a history of weakness in the right upper and lower limb of 3 months duration. She was born out of non-consanguinous marriage and full term normal delivery. Her developmental milestones were normal. She was 132.5 cms tall and weighed 25 kgs. Physical examination revealed ptosis and miosis in the left eye suggesting horner's syndrome. She had decreased power, 3/5 in right upper limb and 4/5 in right lower limb. Her reflexes were brisk in bilateral upper and lower limbs. She had horizontal nystagmus in both eyes and mild sensorineural deafness. Airway examination revealed prominent teeth, neck tilt to right side and congestion of posterior pharyngeal wall.The MRI brain study revealed left vestibular and trigeminal nerve schwannomas and a posterior petrous meningioma on the right side [Table/ Fig-1]. The spine MRI study showed intradural extramedullary lesions at C1-C2, C7, D1-D3 levels and multiple tiny lesions in the region of filum terminale [Table/ Fig-2]. The dorsal lesions were seen extending to posterior mediastinum. The chest radiograph showed tumours occupying both the apices of the lungs, and on right side the lesion had extended to midzone as well [ The patient was scheduled for decompression of the cervicodorsal lesions and excision of the right intrathoracic lesion. ECG, NIBP, ETCO 2 , nasopharyngeal temperature, Entropy, urine output were monitored. The girl was induced with propofol followed by videolaryngoscopy to see if any lesions were present in the larynx complicating intubation. As no abnormalities were detected, the child was intubated with 6.0 mm size cuffed oral endotracheal tube which was facilitated with vecuronium. Invasive monitors used were right radial artery and left jugular venous pressures. Anaesthesia was maintained with O 2 , N 2 O and isoflurane. Analgesia was achieved with intermittent doses of Morphine. Due to massive blood loss estimating to about 2000ml, only cervical tumour was excised and further tumour excision was scheduled later. Intra-operative blood loss was replaced with packed red blood cells and fresh frozen plasma. The vitals were maintained within 20% of the base line values. Post-operatively, the child was extubated and monitored in PICU for two days. A month later, this girl was scheduled for excision of dorsal tumor and its right throracic extension. As proper size double lumen tube was not available for single lung ventilation for thoracic tumour exision, the child was intubated with single lumen 6.0 mm cuffed endotracheal tube. Intraoperatively invasive monitors were initiated and dorsal tumor exision was performed uneventfully. She was positioned in left lateral decubitus position with proper padding to avoid injury to axillary neurovascular bundle. The child was ventilated using air-oxygen mixture and isoflurane with small tidal volumes of 100 -125 ml and respiratory rate of 30-35 min with a PEEP of 4 mm Hg. The EtCO 2 and oxygen saturations were maintained between 35-40 mmHg and above 97% respectively. The arteria...

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“…6 • Spinal tumors may make epidural analgesia difficult; therefore, lumbosacral imaging should be performed before regional analgesia is given. 73,74 Surveillance For at-risk individuals who have either tested positive for the known disease-causing mutation in their families or whose genetic status cannot be clarified by molecular genetic testing:…”

Section: Prevention Of Secondary Complicationsmentioning

confidence: 99%