Obstetrical anaesthesia and analgesia in chronic spinal cord-injured women

Abstract

Improved acuteand rehabilitative careand emphasis on integrating patients into society after spinal cord injury is likely to result in increasing numbers

Woman Giving Birth With Kyphoscoliosis Spinal Cord Injury and Placenta Previa: A Case Report

“…Regular monitoring with capillary blood gas analysis and ventilatory support in the intensive care unit should be considered. In the postpartum period, the paraplegic patients are at an increased risk of urinary tract infection, thrombophlebitis, and pulmonary embolism [7]. At 7 days after operation, she was stable and complained of dyspnea as usual.…”

Anesthesia for cesarean section in a patient with paraplegia resulting from tumour metastases to spinal cord

“…Epidural hematoma and abscess may not be as catastrophic in this patient as in the normal population, but may have increased the chance of further urgent surgery, or decreased this patient's rehabilitation potential. We perceived that the tumour in her spinal canal and the previous back surgery might make epidural catheter placement difficult, 1 and the block ineffective due to restricted local anesthetic spread in the epidural space. Bolus administration of local anesthetic in the epidural space may have caused further compression of the spinal cord.…”

“…Epidural analgesia for the obstetrical patient who presents with preeclampsia or paraplegia with autonomic hyperreflexia may be extremely beneficial and therapeutic. 1 On the other hand, the combination of recent back surgery, thrombocytopenia, a developing and evolving neurological deficit in the face of a febrile parturient with known urosepsis, renders regional analgesia or anesthesia less favourable, if not contraindicated.…”

“…Hypertension, piloerection, flushing, sweating and reflex bradycardia are common symptoms occurring with stimulation below the level of the lesion. 1 Bladder distention is a common precipitating factor, but uterine contractions, urinary tract infections and acute abdominal pathology are other causes. [12][13][14] The presence or development of autonomic hyperreflexia is related to the level of the spinal cord lesion, with a quoted incidence of 85% if the lesion is higher than T 7 .…”

Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series

“…5 If unrecognized, AH can cause devastating complications during pregnancy such as intracranial hemorrhage, hypertensive encephalopathy and death. 6 Although many case series exist in the obstetric and rehabilitation literature, 5,7-9 only a few case reports 3,10-18 and one case series of three patients 8 focus on the obstetric anesthetic management of patients with paraplegia or tetraplegia for labor and delivery. This case series describes nine pregnancies in eight parturients with paraplegia or tetraplegia.…”