Beyond Spinal Headache

Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA, USA.
Regional Anesthesia and Pain Medicine (Impact Factor: 2.12). 09/2007; 32(5):455-61. DOI: 10.1016/j.rapm.2007.01.008
Source: PubMed

ABSTRACT This Evidence-Based Case Management article evaluates and grades the evidence for two anesthesiology-related interventions: prophylaxis after unintentional meningeal puncture and treatment of spontaneous intracranial hypotension (SIH).
A search was made of relevant English language clinical studies or reports pertinent to the topic of low-pressure headache, but excluding the treatment of meningeal puncture headache.
Thirty-seven case reports, case series, and clinical trials were included to develop the best available evidence-based recommendations for the prophylaxis of unintentional meningeal puncture and for the treatment of SIH.
The highest quality randomized controlled trials suggest that prophylactic epidural blood patch (EBP) does not reduce the incidence of headache after unintentional meningeal puncture. The weight of existing literature supports EBP as an initial treatment of SIH, although its effectiveness does not approach that seen when EBP is used to treat meningeal puncture headache.

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    ABSTRACT: Parturients with intracranial lesions are often assumed to have increased intracranial pressure, even in the absence of clinical and radiographic signs. The risk of herniation after an inadvertent dural puncture is frequently cited as a contraindication to neuraxial anesthesia. This article reviews the relevant literature on the use of neuraxial anesthesia in parturients with known intracranial pathology, and proposes a framework and recommendations for assessing risk of neurologic deterioration, with epidural analgesia or anesthesia, or planned or inadvertent dural puncture. The authors illustrate these concepts with numerous case examples and provide guidance for the practicing anesthesiologist in determining the safety of neuraxial anesthesia.
    Anesthesiology 09/2013; 119(3):703-18. DOI:10.1097/ALN.0b013e31829374c2 · 6.17 Impact Factor
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    ABSTRACT: It is the case of a patient 32 years- old and 34 weeks of gestation with antecedents of severe aortic stenosis that is programmed for caesarean section. She has been displaying progressive symptoms (dyspnea and síncope) reason why she had tried an aortic valvuloplasty with balloon without satisfactory result. The anesthesia for the procedure was spinal continuous through catheter using 3,75 mgs of 0.5% hyperbaric bupivacaina, 25 mcg of fentanyl and 100 mcg morphine, with invasive monitoring of arterial blood pressure and cardiac output. Perioperative maternal or fetal complications did not appear. With this report and the revision of literature, we suggest that the neuroaxial anesthetic techniques are a good alternative to the general anesthesia in pregnated patients with severe aortic valvular stenosis.
    Revista Colombiana de Anestesiologia 12/2008; 37(4):299–303. DOI:10.1016/S0120-3347(09)74005-5
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    ABSTRACT: Objective To review the current research and formulate a rational approach to the physiopathology, cause and treatment of post-dural puncture headache (PDPH).Data sourcesArticles published to December 2011 were obtained through a search of Medline for the MeSh terms “epidural blood-patch” and “post-dural puncture headache”.Study selectionSix hundred and eighty-two pertinent studies were included and 200 were analysed.Data synthesisResulting of a dural tap after spinal anaesthesia or diagnostic lumbar puncture or as a complication of epidural anaesthesia, PDPH occurs when an excessive leak of cerebrospinal fluid leads to intracranial hypotension associated to a resultant cerebral vasodilatation. Reduction in cerebrospinal fluid volume in upright position may cause traction of the intracranial structure and stretching of vessels. Typically postural, headache may be associated to nausea, photophobia, tinnitus or arm pain and changes in hearing acuity. In severe cases, there may be cranial nerve dysfunction and nerve palsies secondary to traction on those nerves. The Epidural Blood-Patch (EBP) is considered as the “gold standard” in the treatment of PDHP because it induces a prolonged elevation of subarachnoid and epidural pressures, whereas such elevation is transient with saline or dextran. EBP should be performed within 24–48 hours of onset of headache; the optimum volume of epidural blood appears to be 15–20 mL. Severe complications following EBP are exceptional. The use of echography may be safety puncture. The optimum timing of epidural blood-patch, the resort of repeating procedure if the symptomatology does not disappear, the alternative to the conventional medical treatment need to be determined by future clinical trial.
    Annales francaises d'anesthesie et de reanimation 05/2013; 32(5):325–338. DOI:10.1016/j.annfar.2013.02.014 · 0.84 Impact Factor