Document Detail

Anesthesia for Cesarean section in a patient with paraplegia resulting from tumour metastases to spinal cord.
MedLine Citation:
PMID:  11097545     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Spinal cord injured patients present multiple unique challenges to the anesthesiologist. These include choice of muscle relaxant and management of autonomic hyperreflexia. We report the anesthetic management for Cesarean delivery in a patient who was paraplegic due to spinal canal metastases. Preeclampsia and fever complicated this case. CLINICAL FEATURES: The patient presented at 29 wk gestation with progressive paraplegia at the T10 level due to metastatic osteosarcoma. She had a decompressive laminectomy without improvement in her paralysis. She subsequently developed preeclampsia at 31 wk gestation, and underwent Cesarean delivery for breech presentation under general anesthesia. Anatomical concerns left us unsure of the efficacy or safety of neuraxial anesthesia. CONCLUSIONS: Preeclampsia and autonomic hyperreflexia are generally indications for regional anesthesia for Cesarean section. Tumour in her spinal canal and laboratory abnormalities including thrombocytopenia and a potential urosepsis dissuaded us from this option. Additionally, rapid sequence induction and intubation were not preferred due to paraplegia, leading us to secure the airway fibreoptically.
B P Jones; B C Milliken; D H Penning
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  47     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  2000 Nov 
Date Detail:
Created Date:  2001-02-23     Completed Date:  2001-03-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  1122-8     Citation Subset:  IM    
Department of Anesthesia, Tripler Army Medical Center, Hawaii 96859-5000, USA. Brian_P.Jones@TAMC.CHCS.AMEDD.ARMY.MIL
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MeSH Terms
Anesthesia, Obstetrical*
Cesarean Section
Paraplegia / etiology*,  physiopathology
Pre-Eclampsia / physiopathology
Pregnancy Complications, Neoplastic / physiopathology*
Spinal Cord Neoplasms / complications,  secondary*

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