1
|
Chatelain LS, Marie-Hardy L, Khalifé M, Glorion C, Garreau De Loubresse C, Guigui P, Ferrero E. Pregnancy and childbirth after adolescent idiopathic scoliosis surgery: A study of 80 pregnancies. Orthop Traumatol Surg Res 2023:103711. [PMID: 37863186 DOI: 10.1016/j.otsr.2023.103711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a common spinal disease affecting 2% of adolescents, and women in 90% of the cases. When a surgical treatment is opted for, many questions are frequently asked by families and patients about the course of pregnancy and childbirth after the spinal fusion. This subject remains little studied in the literature, especially with modern instrumentation techniques. HYPOTHESIS The goal was to describe pregnancy and childbirth after AIS surgery in terms of access to epidural analgesia, need for cesarean section (c-section), and low back pain during and after pregnancy. We thus hypothesized that women undergoing spinal surgery for AIS have subsequently uncomplicated pregnancies and childbirths, and have access to epidural analgesia as women without AIS do. PATIENTS AND METHODS In this retrospective multicenter study, 198 women who underwent surgery between 1984 and 2014 were reviewed from two university hospitals. Among them, 50 women became pregnant, for a total of 80 pregnancies. Surgical data were collected [approach, uppermost and lowermost instrumented vertebra (UIV, LIV)]. Pregnancy characteristics were evaluated: time between surgery and pregnancy, number of births, mode of analgesia, type of delivery, weight gain. Occurrence of low back pain during pregnancy and at follow-up was recorded using ODI. RESULTS Of the 50 women, 34 had posterior surgery and 16 had anterior surgery. Deliveries took place from 1988 to 2018. Of the 80 pregnancies, 81% were delivered by vaginal route (n=65/80), and an effective epidural anesthesia was performed for 49% of them (n=39/80). Epidural analgesia failed in 9% of pregnancies (n=7/80), and was denied in 35% of cases (n=28/80), half of the time by anesthesiologists (n=15/80). Patients refused epidural in 13 pregnancies (16%, n=13/80). A general anesthesia was used in six pregnancies (8%, n=6/80), for c-sections only. Back pain was reported in 48% of the pregnancies (n=38/80). The level of fusion was correlated with c-section, and conversely with epidural anesthesia. DISCUSSION A normal pregnancy with vaginal delivery seems to be the rule for women undergoing spinal fusion for AIS. The c-section rate in AIS women was similar to the general population (19%). Yet, access to epidural anesthesia still seems problematic with only 49% of births in this series, compared with 81% in the French population. LEVEL OF EVIDENCE IV, retrospective cohort.
Collapse
Affiliation(s)
- Léonard Swann Chatelain
- Department of Orthopedic Surgery, Hôpital européen Georges Pompidou (HEGP), Paris University, Paris, France.
| | - Laura Marie-Hardy
- Department of Orthopedic Surgery, Hôpital de la Pitié Salpêtrière, Paris University, Paris, France; Department of Orthopedic Surgery, Hôpital Necker-Enfants malades, Paris University, Paris, France
| | - Marc Khalifé
- Department of Orthopedic Surgery, Hôpital européen Georges Pompidou (HEGP), Paris University, Paris, France
| | - Christophe Glorion
- Department of Orthopedic Surgery, Hôpital Necker-Enfants malades, Paris University, Paris, France
| | | | - Pierre Guigui
- Department of Orthopedic Surgery, Hôpital européen Georges Pompidou (HEGP), Paris University, Paris, France
| | - Emmanuelle Ferrero
- Department of Orthopedic Surgery, Hôpital européen Georges Pompidou (HEGP), Paris University, Paris, France
| |
Collapse
|
2
|
Hernandez NS, Begashaw B, Riesenburger RI, Kryzanski JT, Liu P. Spinal anesthesia in elective lumbar spinal surgery. Anesth Pain Med (Seoul) 2023; 18:349-356. [PMID: 37919919 PMCID: PMC10635856 DOI: 10.17085/apm.23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 11/04/2023] Open
Abstract
Spinal anesthesia (SA) is gaining recognition as a safe and efficacious regional alternative to general anesthesia for elective lumbar surgery. However, unfamiliarity with management issues related to its use has limited the adoption of awake spine surgery, despite its benefits. Few centers in the United States routinely offer SA for elective lumbar surgery, and a comprehensive workflow to standardize SA for lumbar surgery is lacking. In this article, we examine recent literature on the use of SA in lumbar surgery, review the experience of our institution with SA in lumbar surgery, and provide a cohesive outline to streamline the implementation of SA from the perspective of the anesthesiologist. We review the critical features of SA in contemporary lumbar surgery, including selection of patients, methods of SA, intraoperative sedation, and management of several important technical considerations. We aimed to flatten the learning curve to improve the availability and accessibility of the technique for eligible patients.
Collapse
Affiliation(s)
| | - Benayas Begashaw
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA
| | | | | | - Penny Liu
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
3
|
Chapek M, Kessler A, Poon S, Cho R, Nguyen C, Kessler J. The Effect of Adolescent Idiopathic Scoliosis on Natural Delivery and Epidural Use in Pregnant Females: A Matched Cohort Study. Spine (Phila Pa 1976) 2023; 48:E188-E195. [PMID: 36745423 DOI: 10.1097/brs.0000000000004592] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/05/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective matched cohort study. OBJECTIVE The aim of this study was to determine whether females with idiopathic scoliosis (IS), both with and without spine fusion, experience different rates of cesarean section (CS) and epidural anesthesia (EA) than females without scoliosis. SUMMARY OF BACKGROUND DATA IS is a common spine condition with a higher prevalence in females. It is unclear whether females with scoliosis, treated nonoperatively or operatively, have different rates of cesarean delivery or EA. MATERIALS AND METHODS Patients with IS who delivered in our integrated health care system during a 6-year period were identified (N = 1810). They were matched with a group without scoliosis who delivered during the same period (N = 1810). Rates and relative risk (RR) of CS and EA between cohorts and subgroups were calculated. RESULTS The scoliosis cohort had significantly higher rates and RR of EA ( P = 0.002 and P = 0.004, respectively). Scoliosis patients treated nonoperatively had an 8% greater RR of EA ( P = 0.004) and had a significantly lower rate of CS (23.2% vs . 26%, P = 0.048) compared with the control group. Among only scoliosis patients, those treated with spine fusion had a 38% decreased RR of EA ( P < 0.001). Distal fusion level did not seem to influence the RR of EA or CS. CONCLUSIONS Females with scoliosis were significantly more likely to receive EA at delivery compared with females without scoliosis. Rates and RR of cesarean delivery were not significantly lower among women with scoliosis, but females treated nonoperatively for scoliosis had a significantly lower CS rate than those without scoliosis. Females treated with spine fusion for scoliosis were far less likely to receive EA than both females without scoliosis and females with scoliosis treated nonoperatively.
Collapse
Affiliation(s)
- Michael Chapek
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA
| | - Adam Kessler
- Kaiser Los Angeles Medical Center, Department of Orthopedics, Los Angeles, CA
| | - Selina Poon
- Shriners Hospital for Children, Pasadena, CA
| | - Robert Cho
- Shriners Hospital for Children, Pasadena, CA
| | | | - Jeffrey Kessler
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA
| |
Collapse
|
4
|
Factor PAA, Pelaez-Crisologo MC. Obstetric management of a parturient with severe idiopathic scoliosis. BMJ Case Rep 2023; 16:e251405. [PMID: 36882262 PMCID: PMC10008154 DOI: 10.1136/bcr-2022-251405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Scoliosis complicates pregnancy due to increased operative deliveries, restrictive pulmonary disease and anaesthetic difficulties. This is a case of a primigravid with severe scoliosis who underwent primary caesarean section under spinal block with isobaric anaesthetic combined with intravenous sedation postdelivery of the baby. This case highlights the importance of a multidisciplinary approach in the management of parturient with severe scoliosis, from the preconception period until the postpartum stage.
Collapse
Affiliation(s)
- Patricia Ann Africa Factor
- Obstetrics and Gynecology, University of the Philippines Manila College of Medicine, Manila, Philippines
| | | |
Collapse
|
5
|
Sciscent BY, Bhanja D, Daggubati LC, Ryan C, Hallan DR, Rizk EB. Pregnancy in spina bifida patients: a comparative analysis of peripartum procedures and complications. Childs Nerv Syst 2023; 39:625-632. [PMID: 36278978 DOI: 10.1007/s00381-022-05705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Spina bifida (SB) is caused by a failure in neural tube closure that can present with lower extremity sensory deficits, paralysis, and hydrocephalus. Medical advances have allowed increased pregnancies among SB patients, but management and pregnancy-associated complications have not been thoroughly investigated. The objective is to delineate peripartum procedures and complications in patients with SB. METHODS A national de-identified database, TriNetX, was retrospectively queried to evaluate pregnant SB patients and the general population. Procedures and complications were investigated using corresponding ICD-10 and CPT codes within 1 year of pregnancy diagnosis. RESULTS 11,405 SB patients were identified and compared to 9,269,084 non-SB patients. SB patients were significantly more likely to undergo cesarean delivery (1.200; 95% CI [1.133-1.271]) and less likely to receive neuraxial analgesia (0.406; 95% CI [0.383-0.431]). Additionally, patients with SB had an increased risk of seizures (3.922; 95% CI [3.529-4.360]) and venous thromboembolism (VTE) (3.490; 95% CI [3.070-3.969]). Risks of preeclampsia and hemorrhage were comparable. SB patients with hydrocephalus and Chiari malformation type 1 (CM-1) or type 2 (CM-2) were compared to patients without these comorbid conditions. This sub-group analysis showed a significantly increased risk of having cesarean deliveries (SB with hydrocephalus: 12.55%, S.B. with CM-1 or CM-2: 12.81% vs. SB without hydrocephalus or CM, 6.16%) and VTE (3.74%, 2.43% vs. 0.81%). There were also increased risks of hemorrhage and seizures and decreased use of neuraxial analgesia, but the sample size was insufficient. CONCLUSION SB patients were more likely to undergo cesarean section and exhibit peripartum complications compared to those without SB.
Collapse
Affiliation(s)
- Bao Y Sciscent
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA.
- Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA, 17033, USA.
| | - Debarati Bhanja
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
- Penn State College of Medicine, 700 HMC Crescent Rd, Hershey, PA, 17033, USA
| | | | - Casey Ryan
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
| | - David R Hallan
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
| | - Elias B Rizk
- Department of Neurosurgery, Penn State Health, Hershey, PA, 17033, USA
| |
Collapse
|
6
|
Singh P, Singh R, Sardana R. Spinal anaesthesia in kyphoscoliotic parturients undergoing caesarean delivery – A retrospective study from a tertiary care centre in India. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.4103/joacc.joacc_78_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
7
|
Atoot A, Paganessi M, Block M, Schlesinger MD. Horner's Syndrome Secondary to Epidural Anesthesia After Scoliosis Correction: A Case Report. Cureus 2021; 13:e20071. [PMID: 34987935 PMCID: PMC8719307 DOI: 10.7759/cureus.20071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/05/2022] Open
Abstract
Horner’s syndrome is a clinical triad composed of ptosis, miosis, and facial anhidrosis. Overall, this complication is rare but well-documented in the obstetric population receiving labor epidural analgesia, which usually follows a relatively benign transient course. Less commonly, few cases of Horner’s syndrome have been reported in the pediatric population following surgical correction of scoliosis with epidural placement. We present a rare case of a pediatric patient that developed Horner’s syndrome secondary to epidural anesthesia following surgical correction of scoliosis.
Collapse
|
8
|
Berndl A, Ladhani N, Wilson RD, Basso M, Jung E, Tarasoff LA, Angle P, Soliman N. Directive clinique no 416 : Soins pendant l'accouchement et la période post-partum chez les personnes ayant un handicap physique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:781-794.e1. [PMID: 33621681 DOI: 10.1016/j.jogc.2021.02.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
9
|
Berndl A, Ladhani N, Wilson RD, Basso M, Jung E, Tarasoff LA, Angle P, Soliman N. Guideline No. 416: Labour, Delivery, and Postpartum Care for People with Physical Disabilities. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:769-780.e1. [PMID: 33631321 DOI: 10.1016/j.jogc.2021.02.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe evidence-based practice for managing the labour, delivery, and postpartum care of people with physical disabilities in Canada. TARGET POPULATION This guideline addresses the needs of people with physical disabilities, with a focus on conditions that affect strength and mobility, as well as those that affect neurological or musculoskeletal function or structure. Although aspects of this guideline may apply to people with solely intellectual, developmental, or sensory disabilities (e.g., hearing and vision loss), the needs of this population are beyond the scope of this guideline. OUTCOMES Safe and compassionate care for people with physical disabilities who are giving birth. BENEFITS, HARMS, AND COSTS Implementation of this guideline will improve health care provider awareness of specific complications people with physical disabilities may experience during labour, delivery, and the postpartum period and therefore increase the likelihood of a safe birth. EVIDENCE A literature review was conducted using MEDLINE (474), Embase (36), and the Cochrane Central Register of Controlled Trials (CENTRAL; 28) databases. The results have been filtered for English language, publication date of 2013 to present, observational studies, systematic reviews, meta-analyses, and guidelines and references in these publications were also reviewed. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Maternal-fetal medicine specialists, obstetricians, family physicians, nurses, midwives, neurologists, physiatrists, and those who care for people with physical disabilities. RECOMMENDATIONS
Collapse
|
10
|
Kirby GA, Guo W, Mitchell JD, Ma H. Using Lumbar X-Ray to Facilitate Modified Taylor's Approach of Spinal Anesthesia in an Elderly Patient With Scoliosis. Cureus 2021; 13:e12556. [PMID: 33564547 PMCID: PMC7863049 DOI: 10.7759/cureus.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In geriatric patients scheduled for hip or knee surgery, neuraxial anesthesia is a safe and effective anesthesia method and may be a better option than general anesthesia. Unfortunately, establishing neuraxial anesthesia is not always easy in this group of patients. Anatomical abnormalities, such as spinal stenosis, scoliosis, and narrowed interspaces, contribute to the difficulties that anesthesiologists face while performing these procedures. The classic Taylor’s approach targets the widest interspace, L5-S1, as the needle insertion site and accordingly has an increased success rate in difficult neuraxial anesthesia. As this technique historically relies solely on palpation, it might be difficult in patients with less prominent or distorted anatomic landmarks. Ultrasonography or fluoroscopy guidance may help to better target the epidural or subarachnoid space, but both have limitations due to equipment availability or provider expertise. The modified Taylor’s approach we propose in this case report is based on preoperative lumbar x-ray interpretation when point-of-care image guidance cannot be performed. By measuring on the patient’s preoperative lumbar x-ray, we successfully performed a modified Taylor's approach of spinal anesthesia on an elderly patient with severe scoliosis. She underwent open reduction and internal fixation (ORIF) of the left femur with satisfactory pain control and no complications.
Collapse
Affiliation(s)
- Gregory A Kirby
- Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Wenjuan Guo
- Anesthesiology, Peking Union Medical College Hospital, Beijing, CHN
| | - John D Mitchell
- Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Haobo Ma
- Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| |
Collapse
|
11
|
Swany L, Larson AN, Shah SA, Grabala P, Milbrandt T, Yaszemski MJ. Outcomes of pregnancy in operative vs. nonoperative adolescent idiopathic scoliosis patients at mean 30-year follow-up. Spine Deform 2020; 8:1169-1174. [PMID: 32578160 DOI: 10.1007/s43390-020-00158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine whether patients who underwent surgical treatment of adolescent idiopathic scoliosis (AIS) in childhood would have an increased C-section risk in adulthood. Although the impact of scoliosis on future pregnancy and child delivery is a common question for patients and parents, there is limited data regarding pregnancy outcomes following childhood treatment of AIS. METHODS Between 1975 and 1992, 60 female patients underwent treatment for AIS with bracing, surgery, or observation and had data available regarding obstetrical history in the electronic medical record or in paper charts. In childhood, 28 had nonoperative treatment and 32 had fusion surgery. During the follow-up period, 2 nonoperative patients and 1 operative patient had fusion surgery in adulthood, but after childbearing years. Mean age at latest follow-up was 43 years (CI 38, 48). Meantime to follow-up since childhood treatment was 31 years (CI 26, 35). RESULTS 29% of nonoperative patients had a C-section with at least one live birth compared to 38% of operative patients (p = 0.464). For surgical patients fused to L3 or lower, 46% required at least one C-section, compared to 32% of patients fused to L2 or higher (p = 0.40). Overall, 33% of the cohort of patients-including those with all scoliosis treatment methods-required at least one C-section, compared to the state weighted C-section rate of 20.5% (p = 0.014). The percentage of patients with operative treatment-including all levels of fusion-requiring at least one C-section was statistically different than the weighted state C-section rate (p = 0.020). CONCLUSION In this long-term cohort of 60 US scoliosis patients, childhood operative fusion treatment was associated with a statistically significant increased incidence of C-section compared to the state incidence at both the patient level and the delivery level. LEVEL OF EVIDENCE III, comparative cohort study.
Collapse
Affiliation(s)
- Lauren Swany
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 200 1st St SW, USA
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 200 1st St SW, USA.
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Pawel Grabala
- Department of Pediatric Orthopaedic Surgery and Traumatology, Medical University of Bialystok, Bialystok, Poland
| | - Todd Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 200 1st St SW, USA
| | - Michael J Yaszemski
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 200 1st St SW, USA
| |
Collapse
|
12
|
Yoo S, Kim Y, Park SK, Ji SH, Kim JT. Ultrasonography for lumbar neuraxial block. Anesth Pain Med (Seoul) 2020; 15:397-408. [PMID: 33329842 PMCID: PMC7724125 DOI: 10.17085/apm.20065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022] Open
Abstract
Ultrasonography can be useful to perform a lumbar neuraxial block. It aids in understanding the anatomy of the lumbar spine before the procedure. Pre-procedural ultrasound imaging provides information about the accurate intervertebral level for puncture, optimal needle insertion point, and depth of needle advancement for a successful neuraxial block. The key ultrasonographic views for lumbar neuraxial block include the transverse midline interlaminar and parasagittal oblique views. Ultrasonography can facilitate lumbar neuraxial block in difficult cases, such as the elderly, obese patients, and patients with anatomical abnormality of the lumbar spine. This review elucidates the basics of spinal ultrasonography for lumbar neuraxial block and the current evidence regarding ultrasound-guided neuraxial block in adults.
Collapse
Affiliation(s)
- Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Youngwon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Walsh E, Zhang Y, Madden H, Lehrich J, Leffert L. Pragmatic approach to neuraxial anesthesia in obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system. Reg Anesth Pain Med 2020; 46:258-267. [PMID: 33115718 DOI: 10.1136/rapm-2020-101792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 11/04/2022]
Abstract
Neuraxial anesthesia provides optimal labor analgesia and cesarean delivery anesthesia. Obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system present unique challenges to the anesthesiologist. Potential concerns include mechanical interference, patient injury and the need for imaging. Unfortunately, the existing literature regarding neuraxial anesthesia in these patients is largely limited to case series and rare retrospective studies. The lack of practice guidance may lead to unwarranted fear of patient harm and subsequent avoidance of neuraxial anesthesia for cesarean delivery or neuraxial analgesia for labor, with additional risks of exposure to general anesthesia. In this narrative review, we use available evidence to recommend a framework when considering neuraxial anesthesia for an obstetrical patient with neuraxial pathology.
Collapse
Affiliation(s)
- Elisa Walsh
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yi Zhang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah Madden
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James Lehrich
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa Leffert
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Cao Y, Shu S, Jing W, Zhu Z, Qiu Y, Bao H. Quality of Life During Pregnancy, Caesarean Section Rate, and Anesthesia in Women with a History of Anterior Correction Surgery for Lumbar Scoliosis: A Case-Control Study. Med Sci Monit 2020; 26:e926960. [PMID: 33067410 PMCID: PMC7577072 DOI: 10.12659/msm.926960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background This study investigated the prevalence and severity of low back pain (LBP), caesarean section (C-section) rate, and the anesthesia approaches among lumbar scoliosis patients undergoing anterior correction surgery, and compared them with a healthy control cohort. Material/Methods The inclusion criteria for adolescent idiopathic scoliosis (AIS) patients were: presence of lumbar scoliosis, history of 1 or more pregnancies after surgery, and underwent anterior-only surgery. Healthy women with a history of 1 pregnancy were included as the control group. We recorded the type of delivery, neonatal birth weight, and perinatal complications. The quality of life was also evaluated. Results New-onset LBP was reported in 65.6% of AIS patients, significantly higher than in the control group (p<0.001). C-section was performed in 11 scoliosis patients (34.4%) and 25 healthy controls (31.25%), and the rates were not significantly different between groups (P=0.75). No serious perinatal complications were reported in either group. General anesthesia was used for all C-section AIS patients. The rate of successful neuraxial anesthesia in the control group was significantly higher (P<0.001). Conclusions Compared with the healthy control group, lumbar AIS patients did not experience a higher risk of perinatal complications or C-section rate after anterior surgical correction, but general anesthesia was more commonly used than neuraxial regional anesthesia. LBP was more frequently observed in the post-operative AIS patients.
Collapse
Affiliation(s)
- Yun Cao
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China (mainland)
| | - Shibin Shu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China (mainland)
| | - Wenting Jing
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China (mainland)
| | - Zezhang Zhu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China (mainland)
| | - Yong Qiu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China (mainland)
| | - Hongda Bao
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China (mainland)
| |
Collapse
|
15
|
Park SK, Bae J, Yoo S, Kim WH, Lim YJ, Bahk JH, Kim JT. Ultrasound-Assisted Versus Landmark-Guided Spinal Anesthesia in Patients With Abnormal Spinal Anatomy. Anesth Analg 2020; 130:787-795. [DOI: 10.1213/ane.0000000000004600] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
16
|
Bisherwal S, Puhal S, Saini R, Rani A. Anaesthetic management and challenges involved in goldenhar's syndrome; A series of two cases. BALI JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.4103/bjoa.bjoa_32_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
17
|
Katz R, McCaul CL. Anaesthetic management for caesarean section of a parturient with a known difficult airway and closed spinal dysraphism. Int J Obstet Anesth 2018; 38:137-142. [PMID: 30415798 DOI: 10.1016/j.ijoa.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/15/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
Many anaesthetists consider patients with existing neurological deficits, untreated spinal pathology or those having undergone major spinal intervention to be precluded from undergoing neuraxial anaesthesia. While this is partly rooted in fears of litigation there is also a lack of consensus of the best practice in the anaesthetic management of these patients. We present our management of a parturient who attended our institution, having a number of anaesthetic complexities including a known difficult airway, spinal fusion and persistent spinal cord tethering. She successfully underwent delivery under neuraxial blockade for the delivery of her fourth child. We believe that by undergoing a thorough multidisciplinary clinical evaluation, including the extensive use of neuroimaging and ultrasound, it may be possible to plan and perform safe neuraxial anaesthesia.
Collapse
Affiliation(s)
- R Katz
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland.
| | - C L McCaul
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| |
Collapse
|
18
|
Double Assurance of Epidural Space Detection Using Fiberoptics-Based Needle Design and Autofluorescence Technologies for Epidural Blockade in Painless Labor. SENSORS 2018; 18:s18113592. [PMID: 30360473 PMCID: PMC6264018 DOI: 10.3390/s18113592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/24/2018] [Accepted: 10/19/2018] [Indexed: 11/17/2022]
Abstract
Purpose: Technology of reflectance spectroscopy incorporated with auto-fluorescence spectroscopy were employed to increase the safety of epidural placement in regional anesthesia which is generally used for surgery, epidural anesthesia, post-operative pain control and painless childbirth. Method: Ex vivo study of auto-fluorescence spectroscopy was performed for the para-vertebral tissues contained fat, interspinous ligament, supraspinous ligament and ligamentumflavum by multimode microplate reader at wavelength 405 nm for the purpose of tissue differentiation. A specially designed optic-fiber-embedded needle was employed to incorporate with both reflectance and autofluorescence spectroscopies in order to probe the epidural space as double assurance demands. In vivo study was carried out in a Chinese native swine weighted about 30 kg under intubated general anesthesia with ventilation support. The reflective (405 nm) and autofluorescence signals (λ and λ*) were recorded at 5 different sites by an oscilloscope during the needle puncture procedure from skin to epidural space in the back of the swine. Results: Study of either autofluorescence spectroscopy for tissue samples or ex vivo needle puncture in porcine trunk tissues indicates that ligmentumflavum has at least 10-fold higher fluorescence intensity than the other tissues. In the in vivo study, ligamentumflavum shows a double-peak character for both reflectance and autofluorescence signals. The epidural space is located right after the drop from the double-peak. Both peaks of reflectance and fluorescence are coincident which ensures that the epidural space is correctly detected. Conclusions: The fiber-optical technologies of double-assurance demands for tissue discrimination during epidural needle puncture can not only provide an objective visual information in a real-time fashion but also it can help the operator to achieve much higher success rate in this anesthesia procedure.
Collapse
|
19
|
Dixit D, Theroux MC, Dabney KW, Miller F. Use of caudal epidural catheter in a child with cerebral palsy with prior posterior spine (T1-sacrum) fusion. Indian J Anaesth 2018; 62:80-82. [PMID: 29416157 PMCID: PMC5787898 DOI: 10.4103/ija.ija_562_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Divya Dixit
- Department of Anesthesiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Departments of Perioperative Medicine and Anaesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary C Theroux
- Department of Anesthesiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Departments of Perioperative Medicine and Anaesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kirk W Dabney
- Departments of Perioperative Medicine and Anaesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Freeman Miller
- Departments of Perioperative Medicine and Anaesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| |
Collapse
|
20
|
Raman Spectroscopy Differentiates Each Tissue from the Skin to the Spinal Cord: A Novel Method for Epidural Needle Placement? Anesthesiology 2017; 125:793-804. [PMID: 27466032 DOI: 10.1097/aln.0000000000001249] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Neuraxial anesthesia and epidural steroid injection techniques require precise anatomical targeting to ensure successful and safe analgesia. Previous studies suggest that only some of the tissues encountered during these procedures can be identified by spectroscopic methods, and no previous study has investigated the use of Raman, diffuse reflectance, and fluorescence spectroscopies. The authors hypothesized that real-time needle-tip spectroscopy may aid epidural needle placement and tested the ability of spectroscopy to distinguish each of the tissues in the path of neuraxial needles. METHODS For comparison of detection methods, the spectra of individual, dissected ex vivo paravertebral and neuraxial porcine tissues were collected using Raman spectroscopy (RS), diffuse reflectance spectroscopy, and fluorescence spectroscopy. Real-time spectral guidance was tested using a 2-mm inner-diameter fiber-optic probe-in-needle device. Raman spectra were collected during the needle's passage through intact paravertebral and neuraxial porcine tissue and analyzed afterward. The RS tissue signatures were verified as mapping to individual tissue layers using histochemical staining and widefield microscopy. RESULTS RS revealed a unique spectrum for all ex vivo paravertebral and neuraxial tissue layers; diffuse reflectance spectroscopy and fluorescence spectroscopy were not distinct for all tissues. Moreover, when accounting for the expected order of tissues, real-time Raman spectra recorded during needle insertion also permitted identification of each paravertebral and neuraxial porcine tissue. CONCLUSIONS This study demonstrates that RS can distinguish the tissues encountered during epidural needle insertion. This technology may prove useful during needle placement by providing evidence of its anatomical localization.
Collapse
|
21
|
Differences between anticipated and perceived difficulty and insertion duration of labor epidural techniques among anesthesiologists, nurses and patients. Int J Obstet Anesth 2015; 24:111-6. [DOI: 10.1016/j.ijoa.2014.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/23/2014] [Accepted: 12/14/2014] [Indexed: 11/23/2022]
|
22
|
Moaveni DM, Cohn JH, Zahid ZD, Ranasinghe JS. Obstetric Anesthesiologists as Perioperative Physicians: Improving Peripartum Care and Patient Safety. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-014-0094-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
23
|
Bowens C, Dobie K, Devin C, Corey J. An approach to neuraxial anaesthesia for the severely scoliotic spine. Br J Anaesth 2013; 111:807-11. [DOI: 10.1093/bja/aet161] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
Kumari BG, Samantaray A, Kumar VAK, Durga P, Jagadesh G. Spinal anaesthesia in poliomyelitis patients with scoliotic spine: A case control study. Indian J Anaesth 2013; 57:145-9. [PMID: 23825813 PMCID: PMC3696261 DOI: 10.4103/0019-5049.111839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: There is limited data to predict the course of sub-arachnoid block in poliomyelitis patients with scoliotic spine. So we intended to study the course of intrathecal anaesthesia in these patients in comparison to patients with normal spine using 0.5% bupivacaine (heavy). Methods: In this prospective observational study, 41 poliomyelitic patients scheduled for lower limb corrective surgeries under spinal anaesthesia were enrolled. Patients were studied in two groups (Scolotic spine, n=20; Normal spine, n=21). All patients were injected 2 ml of 0.5% bupivacaine heavy intrathecally in the sitting position. The extent of block, bilateral spread, regression of sensory block and motor block were recorded. Demographic data were analysed using the unpaired t test or the chi square test as applicable. Block characteristics were analysed using the Mann Whitney U test. Results: There was statistically significant difference in bilateral spread of sensory block in between the groups. However, there was no significant difference in the maximum extent of the sensory block and the time taken for two segment regression of sensory block. There was no significant difference in time taken to reach complete motor block and for complete recovery from motor block to its preoperative value. Conclusions: Bilateral symmetrical spread of local anaesthetics through intrathecal route cannot be predicted accurately in patients with scoliotic spine. Spinal anaesthesia can be safely administered in poliomyelitis patients with scoliosis with less adverse effects.
Collapse
Affiliation(s)
- Ballarapu Girija Kumari
- Department of Anaesthesia, Balaji Institute of Surgery, Research and Rehabilitation for the Disabled, Trust Hospital, Tirupati, India
| | | | | | | | | |
Collapse
|
25
|
Anesthetic management of a parturient with VACTERL association undergoing Cesarean delivery. Can J Anaesth 2013; 60:570-6. [DOI: 10.1007/s12630-013-9919-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/13/2013] [Indexed: 11/26/2022] Open
|
26
|
Vercauteren M, Waets P, Pitkänen M, Förster J. Neuraxial techniques in patients with pre-existing back impairment or prior spine interventions: a topical review with special reference to obstetrics. Acta Anaesthesiol Scand 2011; 55:910-7. [PMID: 21574965 DOI: 10.1111/j.1399-6576.2011.02443.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many anaesthetists consider neurological disorders of all kinds as a contraindication for regional anaesthesia particularly for neuraxial techniques. This hesitation is partly rooted in fears of medicolegal problems but also in the heterogeneous literature. Therefore, the present topical review is an attempt to describe the feasibility and the risks of neuraxial techniques in patients with spinal injury, anatomical compromise, chronic back pain or previous spinal interventions, ranging from 'minor' types like epidural blood patches to major surgery such as Harrington fusions. Most reviews and case reports were describing experiences in obstetrics as these patients are more likely to insist on neuraxial blocks. In the acute phase of new neurologic injury, general anaesthesia may be the technique of choice to prevent further haemodynamic and respiratory deterioration. After the acute phase, current evidence is mostly reassuring with respect to the risks of neuraxial blocks as they may even be recommendable in some conditions. Ultrasound technology may be of additional help to increase the success rate. A careful pre-operative examination remains mandatory, while patients should be sufficiently informed about technical aspects and possible relapses or progression of their disease. When necessary, patients should have additional technical and clinical examinations as close as possible to surgery to establish the actual pre-operative status. Most patients may benefit more from spinal techniques rather than from less reliable epidural ones. High concentrations and volumes of local anaesthetics should be avoided at all times, especially in patients with nerve compression, large disc herniation or spinal stenosis.
Collapse
Affiliation(s)
- M Vercauteren
- Department of Anaesthesia, Antwerp University Hospital, Edegem, Belgium.
| | | | | | | |
Collapse
|
27
|
|
28
|
Minville V, Lavidalle M, Bayoumeu F, Parrant O, Fourcade O. Rachianesthésie assistée par l’échographie chez une parturiente avec une scoliose corrigée. ACTA ACUST UNITED AC 2010; 29:501-2. [DOI: 10.1016/j.annfar.2010.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 04/14/2010] [Indexed: 10/19/2022]
|
29
|
The preoperative assessment of obstetric patients. Best Pract Res Clin Obstet Gynaecol 2010; 24:261-76. [PMID: 20047859 DOI: 10.1016/j.bpobgyn.2009.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Accepted: 12/01/2009] [Indexed: 11/23/2022]
Abstract
The importance of early identification and management of the high-risk obstetric patient is emphasised in the Confidential Enquiry into Maternal and Child Health (CEMACH) report. High-risk patients who need anaesthetic input include those with airway problems, cardiorespiratory disease and rare genetic conditions, such as malignant hyperthermia and suxamethonium apnoea. Anaesthetic options for labour analgesia as well as anaesthesia for operative delivery will need to be discussed in detail with the patient if a delivery management plan is to be constructed. Input from other medical teams, such as cardiologists or haematologists, are often needed. Ultimately, these measures should reduce maternal morbidity and mortality.
Collapse
|