201
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The effect of second-stage pushing and body mass index on postdural puncture headache. J Clin Anesth 2017; 37:77-81. [DOI: 10.1016/j.jclinane.2016.10.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 10/03/2016] [Accepted: 10/28/2016] [Indexed: 01/09/2023]
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202
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Lin JP, Zhang SD, He FF, Liu MJ, Ma XX. The status of diagnosis and treatment to intracranial hypotension, including SIH. J Headache Pain 2017; 18:4. [PMID: 28091819 PMCID: PMC5236046 DOI: 10.1186/s10194-016-0708-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/07/2016] [Indexed: 01/03/2023] Open
Abstract
Intracranial hypotension, especially spontaneous intracranial hypotension (SIH), is a well-recognized entity associated with cerebrospinal fluid (CSF) leaks, and has being recognized better in resent years, while still woefully inadequate. An increasing number of factors including iatrogenic factors are realized to involve in development and progression of intracranial hypotension. The diagnosis remains difficult due to the various clinical manifestations, some of which are nonspecific and easily to be neglected. Multiple imaging tests are optional in CSF leakage identification while clinicians are still confronted with difficulties when making selection resulting from superiorities and disadvantages of different imaging tests. Treatments for intracranial hypotension are multifarious but evidence is anecdotal. Values of autologous epidural blood patching (EBP), the mainstay of first-line interventional treatment currently, is getting more and more regards while there are no systematic review of its efficacy and risks. Hereby, the purpose of this review was to reveal the present strategy of intracranial hypotension diagnosis and treatment by reviewing literatures, coupled with our experience in clinical work.
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Affiliation(s)
- Jin-Ping Lin
- Department of Anesthesiology & Pain Management, Center for Intracranial Hypotension Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - Shu-Dong Zhang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - Fei-Fang He
- Department of Anesthesiology & Pain Management, Center for Intracranial Hypotension Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China.
| | - Min-Jun Liu
- Department of Anesthesiology & Pain Management, Center for Intracranial Hypotension Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - Xiao-Xu Ma
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
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203
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Eldabe S, Buchser E, Duarte RV. Complications of Spinal Cord Stimulation and Peripheral Nerve Stimulation Techniques: A Review of the Literature. PAIN MEDICINE 2017; 17:325-36. [PMID: 26814260 DOI: 10.1093/pm/pnv025] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Spinal cord and peripheral neurostimulation techniques have been practiced since 1967 for the relief of pain, and some techniques are also used for improvement in organ function. Neuromodulation has recognized complications, although very rarely do these cause long-term morbidity. The aim of this article is to present a review of complications observed in patients treated with neurostimulation techniques. METHODS A review of the major recent publications in the literature on the subjects of spinal cord, occipital, sacral, and peripheral nerve field stimulation was conducted. RESULTS The incidence of complications reported varies from 30% to 40% of patients affected by one or more complications. Adverse events can be subdivided into hardware-related complications and biological complications. The commonest hardware-related complication is lead migration. Other lead related complications such as failure or fracture have also been reported. Common biological complications include infection and pain over the implant. Serious biological complications such as dural puncture headache and neurological damage are rarely observed. CONCLUSIONS Spinal cord and peripheral neurostimulation techniques are safe and reversible therapies. Hardware-related complications are more commonly observed than biological complications. Serious adverse events such as neurological damage are rare.
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204
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Onal O, Aslanlar E, Apiliogullari S, Erkocak OF, Celik JB. Hematoma subdural pós-espinal hiperagudo. Braz J Anesthesiol 2017; 67:110-112. [DOI: 10.1016/j.bjan.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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205
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Channabasappa SM, Manjunath S, Bommalingappa B, Ramachandra S, Banuprakash S. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache following spinal anesthesia. Saudi J Anaesth 2017; 11:362-363. [PMID: 28757848 PMCID: PMC5516510 DOI: 10.4103/sja.sja_59_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shivakumar M Channabasappa
- Department of Anaesthesiology, Subbaiah Institute of Medical Sciences and Maax Super Speciality Hospital, Shimoga, Karnataka, India
| | - Shonali Manjunath
- Department of Obstetrics and Gynecology, Subbaiah Institute of Medical Sciences and Maax Super Speciality Hospital, Shimoga, Karnataka, India
| | - Basavaraj Bommalingappa
- Department of Anaesthesiology, Subbaiah Institute of Medical Sciences and Maax Super Speciality Hospital, Shimoga, Karnataka, India
| | - Sreenivas Ramachandra
- Department of Anaesthesiology, Subbaiah Institute of Medical Sciences and Maax Super Speciality Hospital, Shimoga, Karnataka, India
| | - S Banuprakash
- Department of Anaesthesiology, Subbaiah Institute of Medical Sciences and Maax Super Speciality Hospital, Shimoga, Karnataka, India
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206
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Electron Microscopy of Dural and Arachnoid Disruptions After Subarachnoid Block. Reg Anesth Pain Med 2017; 42:709-718. [DOI: 10.1097/aap.0000000000000667] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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207
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Akdemir MS, Kaydu A, Yanlı Y, Özdemir M, Gökçek E, Karaman H. The Postdural Puncture Headache and Back Pain: The Comparison of 26-gauge Atraucan and 26-gauge Quincke Spinal Needles in Obstetric Patients. Anesth Essays Res 2017; 11:458-462. [PMID: 28663641 PMCID: PMC5490108 DOI: 10.4103/0259-1162.194591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: The postdural puncture headache (PDPH) and postdural puncture backache (PDPB) are well-known complications of spinal anesthesia. There are some attempts to reduce the frequency of complication such as different design of the spinal needles. Aims: The primary outcome of this study is to compare the incidence of PDPH between 26-gauge Atraucan and 26-gauge Quincke spinal needles in elective cesarean operations. The severity of symptoms, the incidence of backache, technical issues, and comparison of cost of needles are secondary outcomes. Materials and Methods: After Investigational Review Board approval, a randomized, prospective, double-blinded study was designed in 682 American Society of Anesthesiologists I–II women having elective cesarean operations under spinal anesthesia. Patients were divided into two groups as 26-gauge Atraucan Group A (n = 323) and 26-gauge Quincke spinal needles Group Q (n = 342). All patients were questioned about backache 1 week later. Differences between categorical variables were evaluated with Chi-square test. Continuous variables were compared by Student's t-test for two independent groups. A two-sided P < 0.05 was considered statistically significant for all analyses. Results: There were no significant differences between groups in all demographic data. The one attempt success rate of the dural puncture in Group A (70,58%) and in Group Q (69.3%) was similar (P > 0.05). The incidence of PDPH was 6.5% in Group A and 4.9% in Group Q (P > 0.05). The epidural blood patch was performed to the three patients in Group A and five patients in Group Q who had severe headache (P > 0.05). The incidence of PDPB was 4.33% versus 2.04% in Group A and Group Q (P > 0.05). Conclusions: The incidence of complication rates and technical handling characteristics did not differ between two groups. Quincke needle is cheaper than Atracaun needle, so it can be a cost-effective choice in obstetric patients.
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Affiliation(s)
- Mehmet Salim Akdemir
- Department of Anaesthesiolgy, Umraniye Research and Education Hospital, Istanbul, Turkey
| | - Ayhan Kaydu
- Department of Anaesthesiolgy, Diyarbakir State Hospital, Diyarbakir, Turkey
| | - Yonca Yanlı
- Department of Anaesthesiolgy, Umraniye Research and Education Hospital, Istanbul, Turkey
| | - Mehtap Özdemir
- Department of Anaesthesiolgy, Umraniye Research and Education Hospital, Istanbul, Turkey
| | - Erhan Gökçek
- Department of Anaesthesiolgy, Diyarbakir State Hospital, Diyarbakir, Turkey
| | - Haktan Karaman
- Department of Anaesthesiolgy, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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208
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Epidural Blood Patch. PAIN MEDICINE 2017. [DOI: 10.1007/978-3-319-43133-8_70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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209
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Weinstock MB, Jaque JM, Herbert M, Jhun P. Postpartum Headaches. Ann Emerg Med 2017; 69:145-148. [DOI: 10.1016/j.annemergmed.2016.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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210
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Lotfy Mohammed E, El Shal SM. Efficacy of different size Quincke spinal needles in reduction of incidence of Post-Dural Puncture Headache (PDPH) in Caesarean Section (CS). Randomized controlled study. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2016.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Emad Lotfy Mohammed
- Department of Anaesthesia, ICU & Pain Management, Faculty of Medicine, Misr University for Science & Technology (MUST), 6th of October City, Egypt
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211
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Wong K, Monroe BR. Successful Treatment of Postdural Puncture Headache Using Epidural Fibrin Glue Patch after Persistent Failure of Epidural Blood Patches. Pain Pract 2016; 17:956-960. [PMID: 27910226 DOI: 10.1111/papr.12541] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/16/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Epidural blood patch is the gold standard for the treatment of postdural puncture headache (PDPH) when conservative treatments have failed to provide any relief. However, alternative therapies are lacking when epidural blood patch persistently fails to improve symptoms. Failure to treat PDPH may lead to significant functional impairment of daily living. Alternative therapies should be sought to accelerate recovery from PDPH. CASE REPORT This case describes a woman who developed PDPH secondary to accidental dural puncture during a spinal cord stimulator trial. She was successfully treated with epidural fibrin glue patch after multiple trials of epidural blood patches. CONCLUSION Percutaneous injection of fibrin glue to seal the dural defect demonstrated promising outcomes for both immediate and long-lasting resolution of persistent PDPH in our patient. In the event of epidural blood patch failure, epidural fibrin glue patch may be a reasonable alternative for the treatment of persistent PDPH.
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Affiliation(s)
- Kevin Wong
- Division of Anesthesiology, Geisinger Medical Center, Danville, PA, U.S.A
| | - Brian R Monroe
- Division of Anesthesiology, Geisinger Medical Center, Danville, PA, U.S.A
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212
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Onal O, Aslanlar E, Apiliogullari S, Erkocak OF, Celik JB. Post-spinal hyperacute subdural hematoma. Braz J Anesthesiol 2016; 67:110-112. [PMID: 28017163 DOI: 10.1016/j.bjane.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/08/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Ozkan Onal
- Selcuk University Medical Faculty, Department of Anesthesia and Intensive Care, Konya, Turkey.
| | - Emine Aslanlar
- Selcuk University Medical Faculty, Department of Anesthesia and Intensive Care, Konya, Turkey
| | - Seza Apiliogullari
- Selcuk University Medical Faculty, Department of Anesthesia and Intensive Care, Konya, Turkey
| | - Omer Faruk Erkocak
- Selcuk University Medical Faculty, Department of Orthopedics and Traumatology, Konya, Turkey
| | - Jale Bengi Celik
- Selcuk University Medical Faculty, Department of Anesthesia and Intensive Care, Konya, Turkey
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213
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Bishop KM. Progress and promise of antisense oligonucleotide therapeutics for central nervous system diseases. Neuropharmacology 2016; 120:56-62. [PMID: 27998711 DOI: 10.1016/j.neuropharm.2016.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/15/2016] [Accepted: 12/16/2016] [Indexed: 12/14/2022]
Abstract
Antisense oligonucleotide (ASO) drugs are an emerging class of therapeutics that have recently demonstrated progress and promise to treat diseases of the central nervous system (CNS). ASOs for a variety of targets and mechanisms are currently being investigated in clinical trials and pre-clinically for a number of CNS diseases. This review examines the available data regarding central ASO delivery, distribution, pharmacokinetics, pharmacodynamics and therapeutic opportunities. This article is part of the Special Issue entitled "Beyond small molecules for neurological disorders".
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214
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Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth 2016; 34:194-6. [DOI: 10.1016/j.jclinane.2016.04.009] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/07/2016] [Indexed: 11/19/2022]
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215
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Affiliation(s)
- Gayle B Lourens
- Gayle B. Lourens is an assistant program director, Nurse Anesthesia Program, at Michigan State University College of Nursing, East Lansing, Mich
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216
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Tien JC, Lim MJ, Leong WL, Lew E. Nine-year audit of post-dural puncture headache in a tertiary obstetric hospital in Singapore. Int J Obstet Anesth 2016; 28:34-38. [PMID: 27641087 DOI: 10.1016/j.ijoa.2016.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/04/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The KK Women's and Children's Hospital is a tertiary obstetric unit with approximately 11000 deliveries per year. Epidural analgesia is used in about 40% of laboring women. We reviewed the incidence and management of post-dural puncture headache over a nine-year period. METHODS A retrospective audit of labor epidural analgesia database records from 1 June 2005 to 31 May 2014 was conducted, identifying an "event" as an accidental dural puncture, an inadvertent intrathecal catheter insertion and/or development of a post-dural puncture headache. RESULTS A total of 43434 epidural records were reviewed. Sixty-three events were identified (an incidence of 0.15%). Women had median age of 30years and median body mass index of 27.6kg/m2; 69.8% (44/63) delivered vaginally. Procedures performed by less experienced anesthesiologists and those performed outside office hours were associated with a higher incidence of accidental dural puncture. An intrathecal catheter was inserted in 52 of 58 women (89.7%). Headache developed in 24 of 38 (63.1%) women in whom there was a witnessed accidental dural puncture. Most women who developed post-dural puncture headache presented during the primary admission (36/39; 92.3%). Paracetamol and non-steroidal anti-inflammatory drugs were the most commonly prescribed medications. Six women (9.5%) received an epidural blood patch which led to resolution of headache. CONCLUSION A retrospective audit over a nine-year period at a tertiary teaching hospital found the overall incidence of post-dural puncture headache and associated events to be 0.15%, with a decreasing trend coinciding with improvement in the teaching and supervision of trainees in labor epidural procedures.
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Affiliation(s)
- J C Tien
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore.
| | - M J Lim
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore
| | - W L Leong
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore
| | - E Lew
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore
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217
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Lee LCY, Sennett M, Erickson JM. Prevention and Management of Post–Lumbar Puncture Headache in Pediatric Oncology Patients. J Pediatr Oncol Nurs 2016; 24:200-7. [PMID: 17588892 DOI: 10.1177/1043454207303884] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pediatric oncology patients are at risk for developing a headache after they undergo a lumbar puncture for diagnostic or therapeutic purposes. These headaches are likely due to leakage of cerebrospinal fluid at the puncture site. While usually mild and self-limited, some headaches may be persistent and severe, adding to the distress of these young patients. In the past 10 years, refinements in lumbar needle size and shape as well as procedural techniques have reduced the tissue trauma that predisposes patients to headache. A number of interventions, such as bed rest, hydration, caffeine administration, and epidural blood patching, have been suggested to prevent and relieve the headaches that follow lumbar punctures. This article outlines the pathophysiology and incidence of headaches related to lumbar punctures in the pediatric oncology setting and reviews the evidence from research trials to suggest which interventions clinicians should adopt into their practice to minimize this complication of lumbar punctures.
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218
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Uyar Türkyilmaz E, Eryilmaz NC, Güzey NA, Moraloğlu Ö. Bloqueio bilateral do nervo occipital maior para tratamento de cefaleia pós‐punção dural após cesarianas. Braz J Anesthesiol 2016; 66:445-50. [DOI: 10.1016/j.bjan.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/23/2015] [Indexed: 10/21/2022] Open
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219
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Zorrilla-Vaca A, Healy R, Zorrilla-Vaca C. Finer gauge of cutting but not pencil-point needles correlate with lower incidence of post-dural puncture headache: a meta-regression analysis. J Anesth 2016; 30:855-63. [DOI: 10.1007/s00540-016-2221-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/15/2016] [Indexed: 01/11/2023]
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220
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Bussone G, Tullo V, d'Onofrio F, Petretta V, Curone M, Frediani F, Tonini C, Omboni S. Frovatriptan for The Prevention of Postdural Puncture Headache. Cephalalgia 2016; 27:809-13. [PMID: 17598763 DOI: 10.1111/j.1468-2982.2007.01327.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Efficacy of 5–day treatment with oral frovatriptan 2.5 mg/die for the prophylaxis of post-dural puncture headache (PDPH) was tested in 50 in-patients. A mild headache occurred in 7 (14%) patients for a total of 9 days (p < 0.01 vs. no-PDPH). Most episodes of PDPH occurred in the first days of treatment (only 1 patient had headache at dismissal): 5 patients had only 1 episode, while 2 had headache for 2 consecutive days. No other symptoms were recorded. Occurrence of PDPH in a subgroup of 6 (12%) patients previously submitted to a diagnostic lumbar puncture was also examined: 4 of them reported a PDPH on the previous lumbar puncture in absence of triptans. In only 1 of these 4 patients PDPH recurred under treatment with frovatriptan. In conclusion, our non-randomized open-label study suggests efficacy of oral frovatriptan for PDPH prevention. These results need to be confirmed in a randomized, controlled, double-blind study.
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Affiliation(s)
- G Bussone
- Department of Clinical Neurology, Istituto Nazionale Neurologico C. Besta, Milano, Italy.
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221
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Booth JL, Pan PH, Thomas JA, Harris LC, D'Angelo R. A retrospective review of an epidural blood patch database: the incidence of epidural blood patch associated with obstetric neuraxial anesthetic techniques and the effect of blood volume on efficacy. Int J Obstet Anesth 2016; 29:10-17. [PMID: 27378709 DOI: 10.1016/j.ijoa.2016.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 04/27/2016] [Accepted: 05/30/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The optimal volume of blood required to treat post-dural puncture headache remains in question. In our institution a target volume of 30mL is used for an epidural blood patch unless the patient experiences pain during injection. METHODS The institutional database was retrospectively reviewed for epidural blood patch and delivery statistics over a 15-year period to determine if the volume of blood administered during the procedure directly correlated with the number of epidural blood patches administered. The primary endpoint was defined as the need for a repeat epidural blood patch. RESULTS There were 466 epidural blood patches performed on 394 patients, associated with 84 804 obstetric neuraxial procedures. Thirty-two percent (95% CI 28.3 to 34.9%) of patients who had an inadvertent dural puncture with an epidural needle received an epidural blood patch versus 0.19% (0.16% to 0.22%) of patients who received neuraxial anesthesia with no documented dural puncture with an epidural needle. All patients experienced relief of post-dural puncture headache, although 17% required two and 1.5% required three epidural blood patches. The mean±SD volume of blood administered was 20.5±5.4mL and only 35 patients (8.9%) received 30mL. CONCLUSION Increasing blood volumes up to 30mL did not reduce the need for repeat epidural blood patch. Although the optimal volume of blood to administer during epidural blood patch placement remains unknown, our institution will continue to administer up to 30mL or until the patient experiences pain during epidural injection.
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Affiliation(s)
- J L Booth
- Department of Anesthesiology, Wake Forest University Medical School, Winston-Salem, NC, USA
| | - P H Pan
- Department of Anesthesiology, Wake Forest University Medical School, Winston-Salem, NC, USA
| | - J A Thomas
- Department of Anesthesiology, Wake Forest University Medical School, Winston-Salem, NC, USA
| | - L C Harris
- Department of Anesthesiology, Wake Forest University Medical School, Winston-Salem, NC, USA
| | - R D'Angelo
- Department of Anesthesiology, Wake Forest University Medical School, Winston-Salem, NC, USA.
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222
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Haché M, Swoboda KJ, Sethna N, Farrow-Gillespie A, Khandji A, Xia S, Bishop KM. Intrathecal Injections in Children With Spinal Muscular Atrophy: Nusinersen Clinical Trial Experience. J Child Neurol 2016; 31:899-906. [PMID: 26823478 PMCID: PMC4871174 DOI: 10.1177/0883073815627882] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/20/2015] [Indexed: 12/22/2022]
Abstract
Nusinersen (ISIS-SMNRx or ISIS 396443) is an antisense oligonucleotide drug administered intrathecally to treat spinal muscular atrophy. We summarize lumbar puncture experience in children with spinal muscular atrophy during a phase 1 open-label study of nusinersen and its extension. During the studies, 73 lumbar punctures were performed in 28 patients 2 to 14 years of age with type 2/3 spinal muscular atrophy. No complications occurred in 50 (68%) lumbar punctures; in 23 (32%) procedures, adverse events were attributed to lumbar puncture. Most common adverse events were headache (n = 9), back pain (n = 9), and post-lumbar puncture syndrome (n = 8). In a subgroup analysis, adverse events were more frequent in older children, children with type 3 spinal muscular atrophy, and with a 21- or 22-gauge needle compared to a 24-gauge needle or smaller. Lumbar punctures were successfully performed in children with spinal muscular atrophy; lumbar puncture-related adverse event frequency was similar to that previously reported in children.
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Affiliation(s)
- Manon Haché
- Division of Pediatric Anesthesia, Columbia University Medical Center, New York, NY, USA
| | - Kathryn J Swoboda
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Navil Sethna
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Alan Farrow-Gillespie
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, TX, USA
| | | | - Shuting Xia
- Ionis Pharmaceuticals, Inc., Carlsbad, CA, USA
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223
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Sherfudeen KM, Ramasamy G, Kaliannan SK, Dammalapati PK. Differentiating the headache of cerebral venous thrombosis from post-dural puncture: A headache for anaesthesiologists. Indian J Anaesth 2016; 60:352-4. [PMID: 27212724 PMCID: PMC4870950 DOI: 10.4103/0019-5049.181609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare complication of lumbar puncture. Occasionally, the clinical picture of CVT may mimic post-dural puncture headache (PDPH) resulting in delayed diagnosis. A case of PDPH progressing to CVT is presented and the pathophysiology, diagnostic challenges and management options discussed in this article.
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Affiliation(s)
| | - Gurumoorthi Ramasamy
- Department of Anaesthesiology and Critical Care, Kauvery Hospitals, Trichy, Tamil Nadu, India
| | - Senthil Kumar Kaliannan
- Department of Anaesthesiology and Critical Care, Kauvery Hospitals, Trichy, Tamil Nadu, India
| | - Pavan Kumar Dammalapati
- Department of Anaesthesiology and Critical Care, Kauvery Hospitals, Trichy, Tamil Nadu, India
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Simopoulos TT, Sharma S, Aner M, Gill JS. The Incidence and Management of Postdural Puncture Headache in Patients Undergoing Percutaneous Lead Placement for Spinal Cord Stimulation. Neuromodulation 2016; 19:738-743. [PMID: 27172329 DOI: 10.1111/ner.12445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/16/2016] [Accepted: 04/02/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spinal cord stimulation (SCS) is rapidly expanding therapy for the treatment of refractory neuropathic pain. Although technical issues such as battery life and lead migration have been well studied and improved, little is known about the incidence and management of inadvertent dural puncture and consequent headache. OBJECTIVES The goals of this article were to determine the incidence of postdural puncture headache (PDPH) per lead insertion at the various regions of the spine and to detail the use of conservative management and epidural blood patch (EBP). Long-term outcomes are reviewed to validate treatment modalities employed. METHODS Retrospective analysis of electronic medical records identified by patient implant registry and current procedural terminology data for nearly a 13-year time interval. Operative and postoperative notes were reviewed for details on dural puncture, access technique and spinal level, the development of a PDPH, and the treatment employed with particularly emphasis on the use of (EBP). RESULTS A total of 745 leads inserted resulted in 6 PDPH that were refractory to conservative measures but responded to EBP without long-term complications. The overall incidence of PDPH per lead insertion was 0.81%. Leads placed anterograde in the thoracolumbar (T11-L3) and Cervicothoracic (C7-T5) regions resulted in an incidence of PDPH per lead of 0.63% and 1.1%, respectively, while 5.9% occurred with lumbar retrograde approach, and none with caudal. CONCLUSIONS Dural puncture during SCS device placement and can result in a PDPH that is severe and refractory to conservative modes of therapy. Even in the presence of hardware, EBP performed with meticulous aseptic technique was found to be safe and efficacious.
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Affiliation(s)
- Thomas T Simopoulos
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Sanjiv Sharma
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Musa Aner
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jatinder S Gill
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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225
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Che X, Zhang W, Xu M. Continuous epidural pumping of saline contributes to prevent and treat postdural puncture headache. J Clin Anesth 2016; 34:154-8. [PMID: 27687364 DOI: 10.1016/j.jclinane.2016.03.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 03/16/2016] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE Postdural puncture headache (PDPH) is the most common symptom of accidental dural puncture, a frequent complication of intraspinal anesthesia. We developed a postoperative intervention technique to prevent and treat PDPH in accidental dural puncture patients, including epidural pumping of saline. This retrospective study aimed to retrospectively evaluate this new technique for PDPH prevention and treatment. DESIGN Retrospective study. SETTING Beijing Obstetrics and Gynecology Hospital affiliated to the Capital Medical University, between January 2006 and December 2012. PATIENTS Eighty-seven cases undergoing intraspinal anesthesia were assessed. INTERVENTIONS Of these patients, 68 cases had successful repuncture and were assigned to group A (epidural filling group, n=68), receiving continuous epidural pumping of 0.9% NS (150mL) at a rate of 6mL/h; the remaining cases were assigned to group B (conservative therapy group, n=19). MEASUREMENTS Age, height, and body weight were collected, and postoperative headache was assessed using a visual analog scale. MAIN RESULTS Of 68 patients in group A, 49 (72.1%) developed PDPH, whereas all in group B developed PDPH (P=.009). In addition, all patients showed PDPH within 3days after surgery regardless of treatment group. However, a statistically significant difference was obtained for PDPH duration between groups A and B (P<.001). Multivariate logistic regression analysis showed that frequency of epidural puncture and continuous epidural pumping of saline were significant risk factors for PDPH. CONCLUSIONS Our data indicated that application of 6mL/h saline effectively contributes to PDPH management, and its clinical application should be broadened.
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Affiliation(s)
- Xiangming Che
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China.
| | - Wenyu Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China
| | - Mingjun Xu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China
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226
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JOURNAL CLUB: Incidence of Complications Following Fluoroscopically Guided Lumbar Punctures and Myelograms. AJR Am J Roentgenol 2016; 206:20-5. [PMID: 26700333 DOI: 10.2214/ajr.15.14664] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Headaches due to CSF leak are a well-described complication of dural puncture. It is uncertain how long patients should be observed after dural puncture to reduce the risk of headache. Most of the literature has focused on dural punctures performed without fluoroscopic guidance. The purpose of this study was to determine the incidence of complications from fluoroscopically guided dural punctures, with attention to predictive factors such as the length of bed rest after the procedure. MATERIALS AND METHODS We retrospectively reviewed 2141 fluoroscopically guided dural punctures performed over a 5-year period by a single radiology practitioner assistant. All patients were contacted 48-72 hours after the procedure to assess for complications. Complications were categorized according to whether the patient reported having severe headache (requiring epidural blood patch for treatment), any headache, or any complaint. Using a multivariate logistic regression model, we assessed several possible predictors of complication: patient age, patient sex, needle caliber, puncture site, distance driven after recovery, length of postprocedural bed rest, contrast concentration, and contrast volume. RESULTS In all, 0.8% of patients reported having a severe headache, 2.2% reported having any headache, and 2.6% reported having any complaint. In the multivariate analysis, age and sex were predictive of complication rates (with younger women having higher rates), but the other variables were not predictive. In particular, length of postprocedural bed rest showed statistical equivalence. CONCLUSION Fluoroscopically guided dural punctures result in few complications compared with lumbar punctures performed without fluoroscopic guidance. Postprocedural bed rest greater than 2 hours does not reduce complication rates for fluoroscopically guided lumbar punctures.
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227
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Park SY, Kim JH, Rim JC, Kim JA, Lee JH, Choi SR, Lee SC, Lee JH, Chung CJ. Comparison of spinal anesthesia between the non-elderly and elderly patients. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.2.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sang Yoong Park
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jeong Ho Kim
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jong Cheol Rim
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jeong A Kim
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Ji Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - So Ron Choi
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Seung Cheol Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jong Hwan Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Chan Jong Chung
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
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228
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Leffert L. What's New in Obstetric Anesthesia: The 2014 Gerard W. Ostheimer Lecture. Anesth Analg 2016; 120:1065-1073. [PMID: 25811260 DOI: 10.1213/ane.0000000000000686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lisa Leffert
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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229
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Dale MC, Checketts MR. Complications of regional anaesthesia. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2016. [DOI: 10.1016/j.mpaic.2015.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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230
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Hanling SR, Lagrew JE, Colmenar DH, Quiko AS, Drastol CA. Intravenous Cosyntropin Versus Epidural Blood Patch for Treatment of Postdural Puncture Headache. PAIN MEDICINE 2016; 17:1337-1342. [PMID: 27015690 DOI: 10.1093/pm/pnw014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study evaluated the efficacy of IV cosyntropin as an alternative to epidural blood patch (EBP) for refractory or severe post-dural puncture headache (PDPH). METHODS Twenty-eight patients were randomized to receive EBP or intravenous cosyntropin after diagnosis with post-dural puncture headache. Efficacy was evaluated immediately after treatment and at 1 day, 3 days, and 7 days following treatment using self-reported verbal reported scores for pain and function related to their headache on a 10-point scale using two-way repeated measures analysis of variance (ANOVA) with multiple comparisons. RESULTS Baseline information for the control and study cohorts showed no difference based on intent to treat analysis. EBP showed significant improvement over cosyntropin at day 1 (P < 0.001) for VRS pain and function scores; however, cosyntropin demonstrated similar efficacy to EBP immediately after treatment and days 3 and 7 post treatment (respectively, P = 0.459, P = 0.391 and 0.925 for pain and P = 0.189 and 0.478 for function). Treatment effects remained at day 1 after multivariate analysis (P < 0.001 and P = 0.002 for pain and function, respectively). CONCLUSIONS It is reasonable to consider IV cosyntropin as the treatment of choice for patients in whom EBP is contraindicated or in austere environments where there is limited or no access to anesthesia trained providers. Future research should compare efficacy and cost of prophylaxis to treatment of PDPH with intravenous cosyntropin and evaluate the most effective dosing regimen, including duration, number, and strength of doses.
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Affiliation(s)
| | - Joseph E Lagrew
- Anesthesiology, Naval Medical Center San Diego, San Diego, California.,Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Derrick H Colmenar
- Department of Anesthesiology, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Albin S Quiko
- Anesthesiology, Naval Medical Center San Diego, San Diego, California
| | - Carol A Drastol
- Anesthesiology, Naval Medical Center San Diego, San Diego, California
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231
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Arevalo-Rodriguez I, Ciapponi A, Roqué i Figuls M, Muñoz L, Bonfill Cosp X. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev 2016; 3:CD009199. [PMID: 26950232 PMCID: PMC6682345 DOI: 10.1002/14651858.cd009199.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Post-dural puncture headache (PDPH) is a common complication of lumbar punctures. Several theories have identified the leakage of cerebrospinal fluid (CSF) through the hole in the dura as a cause of this side effect. It is therefore necessary to take preventive measures to avoid this complication. Prolonged bed rest has been used to treat PDPH once it has started, but it is unknown whether prolonged bed rest can also be used to prevent it. Similarly, the value of administering fluids additional to those of normal dietary intake to restore the loss of CSF produced by the puncture is unknown. This review is an update of a previously published review in the Cochrane Database of Systematic Reviews (Issue 7, 2013) on "Posture and fluids for preventing post-dural puncture headache". OBJECTIVES To assess whether prolonged bed rest combined with different body and head positions, as well as administration of supplementary fluids after lumbar puncture, prevent the onset of PDPH in people undergoing lumbar puncture for diagnostic or therapeutic purposes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and LILACS, as well as trial registries up to February 2015. SELECTION CRITERIA We identified randomized controlled trials that compared the effects of bed rest versus immediate mobilization, head-down tilt versus horizontal position, prone versus supine positions during bed rest, and administration of supplementary fluids versus no/less supplementation, as prevention measures for PDPH in people who have undergone lumbar puncture. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies for eligibility through the web-based software EROS (Early Review Organizing Software). Two different review authors independently assessed risk of bias using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We resolved any disagreements by consensus. We extracted data on cases of PDPH, severe PDPH, and any headache after lumbar puncture and performed intention-to-treat analyses and sensitivity analyses by risk of bias. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created a 'Summary of findings' table. MAIN RESULTS We included 24 trials with 2996 participants in this updated review. The number of participants in each trial varied from 39 to 382. Most of the included studies compared bed rest versus immediate mobilization, and only two assessed the effects of supplementary fluids versus no supplementation. We judged the overall risk of bias of the included studies as low to unclear. The overall quality of evidence was low to moderate, downgraded because of the risk of bias assessment in most cases. The primary outcome in our review was the presence of PDPH.There was low quality evidence for an absence of benefits associated with bed rest compared with immediate mobilization on the incidence of severe PDPH (risk ratio (RR) 0.98; 95% confidence interval (CI) 0.68 to 1.41; participants = 1568; studies = 9) and moderate quality evidence on the incidence of any headache after lumbar puncture (RR 1.16; 95% CI 1.02 to 1.32; participants = 2477; studies = 18). Furthermore, bed rest probably increased PDPH (RR 1.24; 95% CI 1.04 to 1.48; participants = 1519; studies = 12) compared with immediate mobilization. An analysis restricted to the most methodologically rigorous trials (i.e. those with low risk of bias in allocation method, missing data and blinding of outcome assessment) gave similar results. There was low quality evidence for an absence of benefits associated with fluid supplementation on the incidence of severe PDPH (RR 0.67; 95% CI 0.26 to 1.73; participants = 100; studies = 1) and PDPH (RR 1; 95% CI 0.59 to 1.69; participants = 100; studies = 1), and moderate quality evidence on the incidence of any headache after lumbar puncture (RR 0.94; 95% CI 0.66 to 1.34; participants = 200; studies = 2). We did not expect other adverse events and did not assess them in this review. AUTHORS' CONCLUSIONS Since the previous version of this review, we found one new study for inclusion, but the conclusion remains unchanged. We considered the quality of the evidence for most of the outcomes assessed in this review to be low to moderate. As identified studies had shortcomings on aspects related to randomization and blinding of outcome assessment, we therefore downgraded the quality of the evidence. In general, there was no evidence suggesting that routine bed rest after dural puncture is beneficial for the prevention of PDPH onset. The role of fluid supplementation in the prevention of PDPH remains unclear.
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Affiliation(s)
- Ingrid Arevalo-Rodriguez
- Division of Research, Fundación Universitaria de Ciencias de la Salud - Hospital de San José/Hospital Infantil de San José, Carrera 19 Nº 8a - 32, Bogotá D.C., Colombia, 11001
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232
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Uyar Türkyilmaz E, Camgöz Eryilmaz N, Aydin Güzey N, Moraloğlu Ö. Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations. Braz J Anesthesiol 2016; 66:445-50. [PMID: 27591456 DOI: 10.1016/j.bjane.2015.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/12/2015] [Accepted: 03/23/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region. GON blockage has been used for the treatment of many kinds of headache. The aim of this retrospective study is to present the results of PDPH treated with GON block over 1 year period in our institute. METHODS 16 patients who had been diagnosed to have PDPH, and performed GON block after caesarean operations were included in the study. GON blocks were performed as the first treatment directly after diagnose of the PDPH with levobupivacaine and dexamethasone. RESULTS The mean VAS score of the patients was 8.75 (±0.93) before the block; 3.87 (±1.78) 10min after the block; 1.18 (±2.04) 2h after the block and 2.13 (±1.64) 24h after the block. No adverse effects were observed. CONCLUSIONS Treatment of PDPH with GON block seems to be a minimal invasive, easy and effective method especially after caesarean operations. A GON block may be considered before the application of a blood patch.
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Affiliation(s)
- Esra Uyar Türkyilmaz
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey.
| | - Nuray Camgöz Eryilmaz
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Nihan Aydin Güzey
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Özlem Moraloğlu
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
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233
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Dhansura T, Shaikh T, Shaikh MA. Comments: New approach to treat an old problem: Mannitol for post dural puncture headache. Indian J Anaesth 2016; 59:762. [PMID: 26755849 PMCID: PMC4697256 DOI: 10.4103/0019-5049.170046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Tasneem Dhansura
- Department of Anaesthesiology and Perioperative Care, Saifee Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Tarana Shaikh
- Department of Anaesthesiology and Perioperative Care, Saifee Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Mohammed Aslam Shaikh
- Department of Anaesthesiology and Perioperative Care, Saifee Hospital, Mumbai, Maharashtra, India. E-mail:
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234
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Chang A, Acquah J, Reddy S, Chao MT. Acupuncture for the Management of Postdural Puncture Headache: A Case Report. Glob Adv Health Med 2016; 5:103-6. [PMID: 26937320 PMCID: PMC4756779 DOI: 10.7453/gahmj.2015.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Postdural puncture headache (PDPH) is a recognized complication of neuraxial anesthesia. This case report documents 1 patient who developed PDPH following epidural anesthesia for postoperative pain control. The patient declined conventional treatments, including an epidural blood patch and intravenous caffeine. This report documents successful use of adjunct acupuncture for the management of PDPH. Additional research on acupuncture as a potential adjunctive therapy for PDPH is needed, particularly for patients who are reluctant to receive more invasive treatments.
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Affiliation(s)
- Alexandra Chang
- Departments of Anesthesiology and Internal Medicine, Loma Linda University (Dr Chang), United States
| | - Joseph Acquah
- Osher Center for Integrative Medicine, University of California San Francisco (Dr Acquah), United States
| | - Sanjay Reddy
- Osher Center for Integrative Medicine, University of California San Francisco (Dr Reddy), United States
| | - Maria T Chao
- Osher Center for Integrative Medicine, University of California San Francisco (Dr Chao), United States
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235
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Yamanaka D, Kawano T, Shigematsu-Locatelli M, Nishigaki A, Kitamura S, Aoyama B, Tateiwa H, Kitaoka N, Yokoyama M. Failure of lumbar puncture in a patient with spinal epidural lipomatosis: a case report. JA Clin Rep 2016; 2:14. [PMID: 29497669 PMCID: PMC5818763 DOI: 10.1186/s40981-016-0040-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/29/2016] [Indexed: 11/10/2022] Open
Abstract
We report a case of difficult lumbar puncture due to the inability to obtain adequate cerebrospinal fluid (CSF) in a patient later diagnosed with spinal epidural lipomatosis (SEL). A 76-year-old man with a body mass index (BMI) of 24.1 kg/m2 was scheduled for transurethral resection of a bladder tumor for superficial bladder cancer under spinal anesthesia. The patient had a 3-year history of inhaled steroid use for the management of chronic obstructive pulmonary disease. After placing the patient in the right lateral position, a lumbar puncture was performed via the median approach. However, CSF could not be tapped adequately despite repeated attempts at lumbar puncture, so general anesthetic was administered instead. Subsequently, both anesthesia and surgery proceeded uneventfully. On the first postoperative day, the patient developed mild postdural puncture headache (PDPH), which was treated conservatively. No postoperative neurological complications related to spinal anesthesia were observed. Approximately 2 months after discharge, the patient reported progressive lower back pain and was diagnosed with SEL by magnetic resonance imaging (MRI). A lumbar laminectomy and removal of excessive adipose tissue was performed. After surgery, the patient's symptoms resolved. The pathogenesis of SEL involves excess fat tissue deposition in the spinal canal, which can lead to obliteration of the spinal subarachnoid space. Therefore, in this patient, the SEL was thought to have caused the inability to obtain adequate CSF during lumbar puncture, and was associated with difficult spinal anesthesia.
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Affiliation(s)
- Daiki Yamanaka
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Takashi Kawano
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Marie Shigematsu-Locatelli
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Atsushi Nishigaki
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Sonoe Kitamura
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Bun Aoyama
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Hiroki Tateiwa
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Noriko Kitaoka
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Masataka Yokoyama
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
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236
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Tanweer O, Kalhorn SP, Snell JT, Wilson TA, Lieber BA, Agarwal N, Huang PP, Sutin KM. Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review. J Cerebrovasc Endovasc Neurosurg 2015; 17:318-23. [PMID: 27065093 PMCID: PMC4823429 DOI: 10.7461/jcen.2015.17.4.318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/21/2014] [Accepted: 08/10/2015] [Indexed: 01/29/2023] Open
Abstract
Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases.
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Affiliation(s)
- Omar Tanweer
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Stephen P Kalhorn
- Department of Neurosurgery, Medical University of South Carolina, SC, USA
| | - Jamaal T Snell
- Department of Anesthesiology, New York University School of Medicine, New York, NY, USA
| | - Taylor A Wilson
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Bryan A Lieber
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Paul P Huang
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Kenneth M Sutin
- Department of Anesthesiology, New York University School of Medicine, New York, NY, USA
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237
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Michaan N, Lotan M, Galiner M, Amzalag S, Many A. Risk factors for accidental dural puncture during epidural anesthesia for laboring women. J Matern Fetal Neonatal Med 2015; 29:2845-7. [PMID: 26593850 DOI: 10.3109/14767058.2015.1107040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Accidental dural puncture (ADP) during epidural analgesia is a debilitating complication. Symptoms of ADP post-dural puncture headache (PDPH) are headache while rising from supine to upright position, nausea, and neck stiffness. While age, gender and needle characteristics are established risk factors for ADP, little is known about risk factors in laboring women. METHODS All cases of ADP during epidural analgesia treated with blood-patching during a 3-years period were retrospectively reviewed. Each case was matched to two controls according to delivery period. RESULTS Forty-nine cases of blood patches after ADP out 17 977 epidural anesthesia procedures were identified (0.27%). No differences were found between cases and controls with regards to body mass index, labor stage at time of epidural, length of second stage, location of epidural along the lumbar vertebrae, anesthesiologist's experience or time when epidural was done. In cases of ADP, significantly lower doses of local anesthetics were injected (10.9 versus 13.5 cc, p < 0.001); anesthesiologists reported significantly more trials of epidurals (70 versus 2.8% more than one trial, p < 0.001), more patient movement during the procedure (13 versus 0%, p < 0.001), more intra-procedure suspicion of ADP (69 versus 0%, p < 0.001) and more cases where CSF/blood was drawn with the syringe (57 versus 2.4%, p < 0.001). CONCLUSION ADP during labor is a rare but debilitating complication. Risk factors for this iatrogenic complication include patient movement and repeated epidural trials. Intra-procedure identification of ADP is common, allowing early intervention with blood patching where indicated.
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Affiliation(s)
| | - Michael Lotan
- a Department of Anesthesia , Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University , Israel
| | | | | | - Ariel Many
- b Department of Obstetrics and Gynecology and
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Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED. Am J Emerg Med 2015; 33:1714.e1-2. [DOI: 10.1016/j.ajem.2015.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022] Open
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Melo MC, Revuelta ME, Santeularia T, Genové M, Català E. [Management of transient radicular pain after receiving an epidural blood patch for headaches due to spontaneous intracranial hypotension]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62:533-535. [PMID: 25698607 DOI: 10.1016/j.redar.2015.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/14/2015] [Accepted: 01/14/2015] [Indexed: 06/04/2023]
Abstract
Spontaneous intracranial hypotension headache is an uncommon disease that resolves spontaneously in most of the cases and in a short period of time. The initial treatment should be symptomatic. In some patients the symptomatology is extremely disabling, and in these cases both the diagnosis and treatment may be performed by an epidural blood patch. A 49-year-old Caucasian woman, with no previous record of epidural or intrathecal puncture, consulted in the Emergency Department complaining of a 9-day history of frontal headache and diplopia, along with nausea and vomiting. The patient was diagnosed with spontaneous intracranial hypotension headache. Considering the symptomatology and the uncontrolled pain, the Pain Unit of our hospital performed an epidural blood patch. In the first 24h the patient reported a remarkable relief of both headache and diplopia but developed a left lumbar radiculopathy that was treated successfully with supportive measures. Transient lumbar radiculopathy is a common and acceptable event secondary to the use of epidural blood patch as a treatment for spontaneous intracranial hypotension headache.
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Affiliation(s)
- M C Melo
- Servicio de Anestesiología y Reanimación, Clínica del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - M E Revuelta
- Servicio de Anestesiología y Reanimación, Clínica del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - T Santeularia
- Servicio de Anestesiología y Reanimación, Clínica del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Genové
- Servicio de Anestesiología y Reanimación, Clínica del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - E Català
- Servicio de Anestesiología y Reanimación, Clínica del Dolor, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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Wu C, Lian Y, Xie N. Aminophylline Injection Alleviates Pain in Postdural Puncture Headache. PAIN MEDICINE 2015; 16:2038-40. [DOI: 10.1111/pme.12804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 04/16/2015] [Accepted: 04/18/2015] [Indexed: 11/29/2022]
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Abstract
In recent years there has been an increased interest in pain neuroscience in physical therapy.1,2 Emerging pain neuroscience research has challenged prevailing models used to understand and treat pain, including the Cartesian model of pain and the pain gate.2-4 Focus has shifted to the brain's processing of a pain experience, the pain neuromatrix and more recently, cortical reorganisation of body maps.2,3,5,6 In turn, these emerging theories have catapulted new treatments, such as therapeutic neuroscience education (TNE)7-10 and graded motor imagery (GMI),11,12 to the forefront of treating people suffering from persistent spinal pain. In line with their increased use, both of these approaches have exponentially gathered increasing evidence to support their use.4,10 For example, various randomised controlled trials and systematic reviews have shown that teaching patients more about the biology and physiology of their pain experience leads to positive changes in pain, pain catastrophization, function, physical movement and healthcare utilisation.7-10 Graded motor imagery, in turn, has shown increasing evidence to help pain and disability in complex pain states such as complex regional pain syndrome (CRPS).11,12 Most research using TNE and GMI has focussed on chronic low back pain (CLBP) and CRPS and none of these advanced pain treatments have been trialled on the thoracic spine. This lack of research and writings in regards to the thoracic spine is not unique to pain science, but also in manual therapy. There are, however, very unique pain neuroscience issues that skilled manual therapists may find clinically meaningful when treating a patient struggling with persistent thoracic pain. Utilising the latest understanding of pain neuroscience, three key clinical chronic thoracic issues will be discussed - hypersensitisation of intercostal nerves, posterior primary rami nerves mimicking Cloward areas and mechanical and sensitisation issues of the spinal dura in the thoracic spine.
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Affiliation(s)
- Adriaan Louw
- International Spine and Pain Institute, Story City, IA, USA
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Tao W, Grant EN, Craig MG, McIntire DD, Leveno KJ. Continuous Spinal Analgesia for Labor and Delivery: An Observational Study with a 23-Gauge Spinal Catheter. Anesth Analg 2015; 121:1290-4. [PMID: 26273746 DOI: 10.1213/ane.0000000000000903] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of the study was to assess postdural puncture headache, pain relief, motor blockade, and success rate of conversion to cesarean delivery anesthesia of a 23-gauge spinal catheter (Wiley Spinal®) for labor analgesia. METHODS After insertion of the spinal catheter, intrathecal bupivacaine 2.5 mg was administered, followed by patient-controlled intrathecal analgesia (basal infusion of 0.0625% bupivacaine with fentanyl 2 μg/mL at a rate of 2 mL/h, demand bolus 1 mL, lockout interval 20 minutes). Bupivacaine 0.5%, up to 25 mg, was administered via the catheter along with fentanyl 20 μg for cesarean delivery anesthesia, if necessary. The catheter was removed after delivery or after 12 hours, whichever was longer. RESULTS One hundred thirteen women were enrolled. In 12 women (11%), the catheter was not successfully inserted or maintained in position. Continuous spinal analgesia was used in 101 women. Three women (2.6%, 95% confidence interval, 0.7%-8.1%) developed postdural puncture headache. There were 83 spontaneous, 12 operative vaginal, and 18 cesarean deliveries. Of the 18 cesarean deliveries, 16 had continuous spinal analgesia when the decision was made to perform a cesarean delivery; conversion from labor analgesia to cesarean anesthesia was successful in 15 women (94%, 95% confidence interval, 67.7%-99.7%). CONCLUSIONS The 23-gauge spinal catheter can be used for analgesia for labor. It can also be converted to surgical anesthesia for cesarean deliveries. Further studies are warranted to determine whether the spinal catheter will be a useful addition to the neuraxial techniques available for obstetric anesthesia care.
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Affiliation(s)
- Weike Tao
- From the *Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas; and †Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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Abstract
BACKGROUND This is an updated version of the original Cochrane review published in Issue 8, 2011, on 'Drug therapy for treating post-dural puncture headache'.Post-dural puncture headache (PDPH) is the most common complication of lumbar puncture, an invasive procedure frequently performed in the emergency room. Numerous pharmaceutical drugs have been proposed to treat PDPH but there are still some uncertainties about their clinical effectiveness. OBJECTIVES To assess the effectiveness and safety of drugs for treating PDPH in adults and children. SEARCH METHODS The searches included the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 6), MEDLINE and MEDLINE in Process (from 1950 to 29 July 2014), EMBASE (from 1980 to 29 July 2014) and CINAHL (from 1982 to July 2014). There were no language restrictions. SELECTION CRITERIA We considered randomised controlled trials (RCTs) assessing the effectiveness of any pharmacological drug used for treating PDPH. Outcome measures considered for this review were: PDPH persistence of any severity at follow-up (primary outcome), daily activity limited by headache, conservative supplementary therapeutic option offered, epidural blood patch performed, change in pain severity scores, improvements in pain severity scores, number of days participants stay in hospital, any possible adverse events and missing data. DATA COLLECTION AND ANALYSIS Review authors independently selected studies, assessed risk of bias and extracted data. We estimated risk ratios (RR) for dichotomous data and mean differences (MD) for continuous outcomes. We calculated a 95% confidence interval (CI) for each RR and MD. We did not undertake meta-analysis because the included studies assessed different sorts of drugs or different outcomes. We performed an intention-to-treat (ITT) analysis. MAIN RESULTS We included 13 small RCTs (479 participants) in this review (at least 274 participants were women, with 118 parturients after a lumbar puncture for regional anaesthesia). In the original version of this Cochrane review, only seven small RCTs (200 participants) were included. Pharmacological drugs assessed were oral and intravenous caffeine, subcutaneous sumatriptan, oral gabapentin, oral pregabalin, oral theophylline, intravenous hydrocortisone, intravenous cosyntropin and intramuscular adrenocorticotropic hormone (ACTH).Two RCTs reported data for PDPH persistence of any severity at follow-up (primary outcome). Caffeine reduced the number of participants with PDPH at one to two hours when compared to placebo. Treatment with caffeine also decreased the need for a conservative supplementary therapeutic option.Treatment with gabapentin resulted in better visual analogue scale (VAS) scores after one, two, three and four days when compared with placebo and also when compared with ergotamine plus caffeine at two, three and four days. Treatment with hydrocortisone plus conventional treatment showed better VAS scores at six, 24 and 48 hours when compared with conventional treatment alone and also when compared with placebo. Treatment with theophylline showed better VAS scores compared with acetaminophen at two, six and 12 hours and also compared with conservative treatment at eight, 16 and 24 hours. Theophylline also showed a lower mean "sum of pain" when compared with placebo. Sumatriptan and ACTH did not show any relevant effect for this outcome.Theophylline resulted in a higher proportion of participants reporting an improvement in pain scores when compared with conservative treatment.There were no clinically significant drug adverse events.The rest of the outcomes were not reported by the included RCTs or did not show any relevant effect. AUTHORS' CONCLUSIONS None of the new included studies have provided additional information to change the conclusions of the last published version of the original Cochrane review. Caffeine has shown effectiveness for treating PDPH, decreasing the proportion of participants with PDPH persistence and those requiring supplementary interventions, when compared with placebo. Gabapentin, hydrocortisone and theophylline have been shown to decrease pain severity scores. Theophylline has also been shown to increase the proportion of participants that report an improvement in pain scores when compared with conventional treatment.There is a lack of conclusive evidence for the other drugs assessed (sumatriptan, adrenocorticotropic hormone, pregabalin and cosyntropin).These conclusions should be interpreted with caution, due to the lack of information to allow correct appraisal of risk of bias, the small sample sizes of the studies and also their limited generalisability, as nearly half of the participants were postpartum women in their 30s.
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Affiliation(s)
- Xavier Basurto Ona
- Emergency Department, Hospital de Figueres, Fundació Salut Empordà, Rda Rector Aroles s/n, Figueres, Girona-Catalunya, Spain, 17600
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Abdulla S, Vielhaber S, Heinze HJ, Abdulla W. A new approach using high volume blood patch for prevention of post-dural puncture headache following intrathecal catheter pump exchange. Int J Crit Illn Inj Sci 2015; 5:93-8. [PMID: 26157652 PMCID: PMC4477403 DOI: 10.4103/2229-5151.158395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: In an observational study, complications of intrathecal catheter pumps necessitating surgical exchange were analyzed. Also the use of a high-volume prophylactic epidural blood patch (EBP) during surgery for preventing post-dural puncture headache (PDPH) with a follow-up for 1 year is described. Materials and Methods: In 22 patients with refractory chronic pain of cancer/noncancer origin or severe spasticity, who were receiving intrathecal morphine including adjuvants or baclofen for symptom relief, catheter exchange with or without pump was performed. In patients with documented symptoms of PDPH following initial intrathecal catheter implantation, a prophylactic EBP with a high blood volume was used for PDPH prevention during surgery. Catheters were replaced using 40 mL EBP before entering dural space at a speed of 5mL/min into the epidural space. Patients were asked to quantify pain experience and functional ability. Results: From a sample of 72 patients admitted for catheter exchange with or without pump, 22 patients (33%) (12 male, 10 female) had a history of PDPH following initial implantation. Diagnostic and therapeutic measures occurring with malfunction of intrathecal catheter pump systems were described. Twenty-one patients were successfully treated with prophylactic EBP, while one patient could not be properly evaluated because of intracranial bleeding as the underlying disease. Conclusions: A new approach using a high-volume prophylactic EBP for preventing PDPH following catheter exchange is presented. The efficacy and safety of this technique for 1 year follow-up have been evaluated and was found to be safe and potentially effective.
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Affiliation(s)
- Susanne Abdulla
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany ; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Walied Abdulla
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany ; Johannes Gutenberg University Mainz, Mainz, Germany
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Castrillo A, Tabernero C, García-Olmos LM, Gil C, Gutiérrez R, Zamora MI, Mendoza A, Rodríguez MF, Guerrero P, Rodríguez-Vico JS, Ferrero M, Morollón N, Duarte J. Postdural puncture headache: impact of needle type, a randomized trial. Spine J 2015; 15:1571-6. [PMID: 25794941 DOI: 10.1016/j.spinee.2015.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 01/20/2015] [Accepted: 03/07/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The most common adverse event after a lumbar puncture (LP) is a headache: In anaesthesiology, well studied is the protective effect of atraumatic spinal needles, and they are routinely used. However, this is less well known in diagnostic LP, and neurologists use atraumatic needles in less than 2% of times. PURPOSE The purpose of this study was to define the impact of needle type, atraumatic (Sprotte [S]) versus traumatic (Quincke [Q]) on postdural puncture headache (PDPH) incidence. STUDY DESIGN The study is based on a prospective, randomized, and simple-blinded clinical trial. PATIENT SAMPLE Patients older than 14 years were scheduled for a diagnostic or therapeutic LP. OUTCOME MEASURES The outcome measure included the development of PDPH according to the International Headache Association criteria. METHODS Patients fulfilling eligibility criteria were randomly allocated to one of two kinds of spinal needle: atraumatic or S-type or traumatic or Q-type. They were interviewed on days 2 and 7 about the development of PDPH. RESULTS The incidence of PDPH was 22.43% with Q-type needle and 8.51% with S-type needle, p=.04. The duration of PDPH in patients in the S-type was 1 day or less, compared with a median of 4.14 days in the Q-type (p=.00). In the logistic regression model, the S-type needle together with the age of the patient were the only two statistically significant factors in the development of postlumbar puncture headache (PLPH), both of them being protective. CONCLUSIONS We found a lower incidence of PDPH with atraumatic needles, and it was statistically significant compared with the traumatic needles. Our study confirms the effectiveness of the atraumatic needles to prevent PDPH.
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Affiliation(s)
- Ana Castrillo
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain.
| | - César Tabernero
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - Luis M García-Olmos
- Multiprofessional Education Unit for Family and Community Care, Madrid (South-East), C/ Hacienda de Pavones 28030, Spain
| | - Cecilia Gil
- Division of Neurology, General Hospital, Burgos, Spain
| | - Raúl Gutiérrez
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - María I Zamora
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - Amelia Mendoza
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - María F Rodríguez
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - Pilar Guerrero
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | | | - Marta Ferrero
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - Noemí Morollón
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
| | - Jacinto Duarte
- Division of Neurology, General Hospital, Segovia Miguel Servet s/n, Segovia 40002, Spain
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Omole OB, Ogunbanjo GA. Postdural puncture headache: evidence-based review for primary care. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2015.1014154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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248
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Monserrate AE, Ryman DC, Ma S, Xiong C, Noble JM, Ringman JM, Morris JC, Danek A, Müller-Sarnowski F, Clifford DB, McDade EM, Brooks WS, Darby DG, Masters CL, Weston PSJ, Farlow MR, Graff-Radford NR, Salloway SP, Fagan AM, Oliver A, Bateman RJ. Factors associated with the onset and persistence of post-lumbar puncture headache. JAMA Neurol 2015; 72:325-32. [PMID: 25622095 DOI: 10.1001/jamaneurol.2014.3974] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE This study assesses factors associated with the most common adverse event following lumbar puncture. OBJECTIVE To identify factors associated with the risk, onset, and persistence of post-dural puncture headache (PDPH). DESIGN, SETTING, AND PARTICIPANTS We performed univariate and multivariable analyses of 338 lumbar punctures in the Dominantly Inherited Alzheimer Network observational study using linear mixed models, adjusting for participant-level and family-level random effects. MAIN OUTCOMES AND MEASURES We directly evaluated associations of 3 post-lumbar puncture outcomes (immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch) with participant age and sex, positioning, collection method, needle size, needle insertion site, and cerebrospinal fluid (CSF) volume collected. RESULTS The incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 PDPHs receiving a therapeutic blood patch (4.4%). Greater volume of CSF collected was associated with increased risk of immediate postprocedural headache, largely owing to a nonlinear increase in risk on collection of volumes above 30 mL (odds ratio, 3.73 for >30 mL and 0.98 for <17 mL). In contrast, collection of higher volumes showed a protective effect in decreasing rates of PDPH at 24-hour follow-up and rates of PDPH receiving a therapeutic blood patch (odds ratio, 0.35 per 10 mL). Although differences in needle size did not reach statistical significance, no participant in the 24G needle group received a therapeutic blood patch compared to 8 of 253 for the larger 22G needles. CONCLUSIONS AND RELEVANCE Factors that acutely lower CSF pressure (eg, seated positioning or extracting very high volumes of CSF) may be associated with transient post-lumbar puncture headache, without increasing rates of persistent PDPH or therapeutic blood patch. Collection of up to 30 mL of CSF appears to be well tolerated and safe.
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Affiliation(s)
- Andrés E Monserrate
- University of Puerto Rico School of Medicine, San Juan2Institute of Clinical and Translational Sciences, Washington University School of Medicine, St Louis, Missouri
| | - Davis C Ryman
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri4Dominantly Inherited Alzheimer Network Clinical Core, Washington University School of Medicine, St Louis, Missouri
| | - Shengmei Ma
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Chengjie Xiong
- Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri
| | - James M Noble
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - John M Ringman
- Mary S. Easton Center for Alzheimer's Disease Research at the University of California, Los Angeles
| | - John C Morris
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri5Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians Universität Munich, Munich, Germany
| | | | - David B Clifford
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Eric M McDade
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William S Brooks
- Neuroscience Research Australia, University of New South Wales, Sydney
| | - David G Darby
- The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Colin L Masters
- The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip S J Weston
- School of Life and Medical Sciences,University College London, London, England
| | - Martin R Farlow
- Indiana Alzheimer Disease Center, Indiana University, Indianapolis
| | | | - Stephen P Salloway
- Memory and Aging Program, Butler Hospital, Brown Medical School, Providence, Rhode Island
| | - Anne M Fagan
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Angela Oliver
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri5Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri
| | - Randall J Bateman
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
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Zuurbier SM, Lauw MN, Coutinho JM, Majoie CBLM, van der Holt B, Cornelissen JJ, Middeldorp S, Biemond BJ, Stam J. Clinical Course of Cerebral Venous Thrombosis in Adult Acute Lymphoblastic Leukemia. J Stroke Cerebrovasc Dis 2015; 24:1679-84. [PMID: 25934140 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/23/2015] [Accepted: 03/27/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a frequent complication in patients with acute lymphoblastic leukemia (ALL). A significant proportion of patients develop cerebral venous thrombosis (CVT). METHODS To investigate risk factors for and the clinical course of CVT in ALL patients, we describe all cases of CVT which occurred in a well-defined cohort of 240 adults, treated for newly diagnosed ALL in the HOVON (Dutch-Belgian Hemato-Oncology Cooperative Group)-37 study. We conducted a nested case-control study to explore the relevance of early symptoms and risk factors for CVT in ALL patients. RESULTS Nine of 240 patients developed CVT (4%). CVT occurred during or shortly after L-asparaginase therapy (in 8 cases) and shortly after intrathecal methotrexate injections (in all cases) during cycle I of remission induction treatment. CVT was associated with prior headache and seizures. In 5 of 9 patients with CVT, headache before the diagnosis of CVT occurred within 3 days after lumbar puncture and initially had a postural character. CONCLUSIONS CVT is relatively common in adult ALL patients. Our data suggest that CVT in adult ALL patients results from the additive effects of multiple risk factors, with a particular role for asparaginase and the effects of lumbar punctures for intrathecal therapy.
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Affiliation(s)
- Susanna M Zuurbier
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mandy N Lauw
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
| | | | - Bronno van der Holt
- HOVON Data Centre, Erasmus MC Cancer Institute-Clinical Trial Centre, Rotterdam, The Netherlands
| | - Jan J Cornelissen
- Department of Hematology, Erasmus MC-Daniel den Hoed, Rotterdam, The Netherlands
| | - Saskia Middeldorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Bart J Biemond
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Stam
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
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Vassal O, Del Carmine P, Beuriat PA, Desgranges FP, Gadot N, Allaouchiche B, Timour-Chah Q, Stewart A, Chassard D. Neurotoxicity of intrathecal 6% hydroxyethyl starch 130/0.4 injection in a rat model. Anaesthesia 2015; 70:1045-51. [PMID: 25907209 DOI: 10.1111/anae.13076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 12/30/2022]
Abstract
Epidural blood patch is the gold standard treatment for post-dural puncture headache, although hydroxyethyl starch may be a useful alternative to blood if the latter is contraindicated. The aim of this experimental study was to assess whether hydroxyethyl starch given via an indwelling intrathecal catheter resulted in clinical or histopathological changes suggestive of neurotoxicity. The study was conducted in rats that were randomly allocated to receive three 10-μl injections on consecutive days of either saline or hydroxyethyl starch administered via the intrathecal catheter. Eight rats were given injections of saline 0.9% and 11 were given 6% hydroxyethyl starch 130/0.4 derived from thin boiling waxy corn starch in 0.9% sodium chloride (Voluven). Daily clinical evaluation, activity measured by actimetry and neuropathological analysis of the spinal cord were subsequently performed to assess for signs of neurotoxicity. No clinical or actimetric changes were observed in either group following intrathecal saline or hydroxyethyl starch administration. Histopathological examination showed non-specific changes with no differences between the two groups. This experimental study in the rat suggests that repeated intrathecal injection of hydroxyethyl starch is not associated with neurotoxicity.
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Affiliation(s)
- O Vassal
- Department of Paediatric Anaesthesia, Hôpital Femme Mère Enfant, Centre Hospitalier Universitaire Lyon, Lyon, France
| | - P Del Carmine
- Aniphy, Claude Bernard University, University of Lyon, Lyon, France
| | - P-A Beuriat
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Centre Hospitalier Universitaire Lyon, Lyon, France
| | - F-P Desgranges
- Department of Paediatric Anaesthesia, Hôpital Femme Mère Enfant, Centre Hospitalier Universitaire Lyon, Lyon, France
| | - N Gadot
- Department of Histology, ANIPath, Laennec University, University of Lyon, Lyon, France
| | - B Allaouchiche
- Department of Paediatric Anaesthesia, Hôpital Femme Mère Enfant, Centre Hospitalier Universitaire Lyon, Lyon, France
| | - Q Timour-Chah
- Aniphy, Claude Bernard University, University of Lyon, Lyon, France
| | - A Stewart
- Department of Anaesthesia, University College Hospital NHS Foundation Trust, London, UK
| | - D Chassard
- Department of Paediatric Anaesthesia, Hôpital Femme Mère Enfant, Centre Hospitalier Universitaire Lyon, Lyon, France
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