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Combined Spinal-Epidural Analgesia for Laboring Parturient with Arnold-Chiari Type I Malformation: A Case Report and a Review of the Literature

Combined Spinal-Epidural Analgesia for Laboring Parturient with Arnold-Chiari Type I Malformation: A Case Report and a Review of the Literature

Authors :
Clark K. Choi
Kalpana Tyagaraj
Source :
Case Reports in Anesthesiology, Case Reports in Anesthesiology, Vol 2013 (2013)
Publication Year :
2013
Publisher :
Hindawi Limited, 2013.

Abstract

Anesthetic management of laboring parturients with Arnold-Chiari type I malformation poses a difficult challenge for the anesthesiologist. The increase in intracranial pressure during uterine contractions, coughing, valsalva maneuvers, and expulsion of the fetus can be detrimental to the mother during the process of labor and delivery. No concrete evidence has implicated high cerebral spinal fluid pressure on maternal and fetal complications. The literature on the use of neuraxial techniques for managing parturients with Arnold-Chiari is extremely scarce. While most anesthesiologists advocate epidural analgesia for management of labor pain and spinal anesthesia for cesarean section, we are the first to report the use of combined spinal-epidural analgesia for managing labor pain in a pregnant woman with Arnold-Chiari type I malformation. Also, we have reviewed the literature and presented information from case reports and case series to support the safe usage of neuraxial techniques in these patients.

Details

ISSN :
20906390 and 20906382
Volume :
2013
Database :
OpenAIRE
Journal :
Case Reports in Anesthesiology
Accession number :
edsair.doi.dedup.....fd07a3b7ddc86b4d1f79347cd71dac98
Full Text :
https://doi.org/10.1155/2013/512915