Öz
The selection of anesthetic methods for labor and delivery in individuals with elevated intracranial pressure relies on careful consideration of the risks and benefits. While neuraxial analgesia and anesthesia are favored for healthy individuals, they might not be suitable for individuals with intracranial lesions or a heightened risk of bleeding. Neuraxial block in post-stroke patients raises a concerning question about its safety due to the risk of herniation. The risk of perioperative major vascular events and mortality between general anesthesia and regional anesthesia in post-stroke patients is comparable. However, the neuraxial block shows benefits regarding airway manipulation and lower risk of thromboembolism. A successful and safe neuraxial anesthesia in a pregnant patient with a history of hemorrhagic stroke was presented in this case report.
Anahtar Kelimeler
Kaynakça
- Benesch C, Glance LG, Derdeyn CP, Fleisher LA, Holloway RG, Messé SR, et al. Perioperative neurological evaluation and management to lower the risk of acute stroke in patients undergoing noncardiac, nonneurological surgery: A scientific statement from the American Heart Association/American Stroke Association. Circulation. 2021;143(19):e923-46.
- Christiansen MN, Andersson C, Gislason GH, Torp-Pedersen C, Sanders RD, Føge Jensen P, et al. Risks of cardiovascular adverse events and death in patients with previous stroke undergoing emergency noncardiac, nonintracranial surgery: The importance of operative timing. Anesthesiology. 2017;127(1):9-19.
- Anson JA, Vaida S, Giampetro DM, McQuillan PM. Anesthetic management of labor and delivery in patients with elevated intracranial pressure. Int J Obstet Anesth. 2015;24(2):147-60.
- Kerscher SR, Zipfel J, Haas-Lude K, Bevot A, Tellermann J, Schuhmann MU. Transorbital point-of-care ultrasound versus fundoscopic papilledema to support treatment indication for potentially elevated intracranial pressure in children. Childs Nerv Syst. 2024;40(3):655-63.
- Karnik HS, Jain RA. Anesthesia for patients with prior stroke. J Neuroanaesth Crit Care. 2018;5(3):150-7.
- Minhas JS, Rook W, Panerai RB, Hoiland RL, Ainslie PN, Thompson JP, et al. Pathophysiological and clinical considerations in the perioperative care of patients with a previous ischaemic stroke: a multidisciplinary narrative review. Br J Anaesth. 2020;124(2):183-96.
Öz
Kafa içi basıncı yüksek olan bireylerde doğum sancısı ve doğum için anestezi yöntemlerinin seçimi, risklerin ve faydaların dikkatli bir şekilde değerlendirilmesine dayanır. Nöroaksiyel analjezi ve anestezi sağlıklı bireyler için tercih edilirken intrakranial lezyonları olan veya kanama riski yüksek olan kişiler için uygun olmayabilir. İnme sonrası hastalarda nöroaksiyel blok, fıtıklaşma riski nedeniyle güvenliği konusunda endişe verici bir soru ortaya çıkarmaktadır. İnme sonrası hastalarda genel anestezi ile bölgesel anestezi arasında perioperatif majör vasküler olay ve mortalite riski karşılaştırılabilir. Bununla birlikte, nöroaksiyel blok, hava yolu manipülasyonu ve daha düşük tromboembolizm riski açısından faydalar göstermektedir. Bu vaka raporunda hemorajik inme öyküsü olan gebe bir hastada başarılı ve güvenli nöroaksiyel anestezi sunulmuştur.
Anahtar Kelimeler
Kaynakça
- Benesch C, Glance LG, Derdeyn CP, Fleisher LA, Holloway RG, Messé SR, et al. Perioperative neurological evaluation and management to lower the risk of acute stroke in patients undergoing noncardiac, nonneurological surgery: A scientific statement from the American Heart Association/American Stroke Association. Circulation. 2021;143(19):e923-46.
- Christiansen MN, Andersson C, Gislason GH, Torp-Pedersen C, Sanders RD, Føge Jensen P, et al. Risks of cardiovascular adverse events and death in patients with previous stroke undergoing emergency noncardiac, nonintracranial surgery: The importance of operative timing. Anesthesiology. 2017;127(1):9-19.
- Anson JA, Vaida S, Giampetro DM, McQuillan PM. Anesthetic management of labor and delivery in patients with elevated intracranial pressure. Int J Obstet Anesth. 2015;24(2):147-60.
- Kerscher SR, Zipfel J, Haas-Lude K, Bevot A, Tellermann J, Schuhmann MU. Transorbital point-of-care ultrasound versus fundoscopic papilledema to support treatment indication for potentially elevated intracranial pressure in children. Childs Nerv Syst. 2024;40(3):655-63.
- Karnik HS, Jain RA. Anesthesia for patients with prior stroke. J Neuroanaesth Crit Care. 2018;5(3):150-7.
- Minhas JS, Rook W, Panerai RB, Hoiland RL, Ainslie PN, Thompson JP, et al. Pathophysiological and clinical considerations in the perioperative care of patients with a previous ischaemic stroke: a multidisciplinary narrative review. Br J Anaesth. 2020;124(2):183-96.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anesteziyoloji |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Erken Görünüm Tarihi | 23 Mart 2024 |
| Yayımlanma Tarihi | 30 Nisan 2024 |
| Gönderilme Tarihi | 10 Aralık 2023 |
| Kabul Tarihi | 3 Mart 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 26 Sayı: 1 |
Kaynak Göster
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