Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1996
[Neurological accidents after epidural anesthesia in obstetrics].
Several neurological complications have been described after epidural anaesthesia, including direct trauma to the spinal cord or nerve roots, epidural haematoma, meningitis, epidural abscess, spinal cord infarction. neurologic toxicity of injected agents. In obstetric practice, these complications are very uncommon. However, their real occurrence may be underrated, partly for medicolegal reasons. Different complication mechanisms are described; they should be kept in mind while evaluating post block neurological deficits so that prompt corrective measures can be taken whenever appropriate to prevent permanent damage.
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The use of intraparenchymatous ICP sensor is becoming increasingly popular at the expense of the traditional intraventricular catheter method, in spite of the impossibility, with the former technic, to correct a possible zero drift. The decision to initiate or discontinue ICP monitoring is essentially based upon whether suggestive aspects of raised ICP are or not present on CT-scan. The degree of basal cisterns effacement is particularly informative. ⋯ Preceding the rise of ICP, there exists a compensation phase during which a progressive decrease of intracranial compliance is the important event. Even more earlier, posttraumatic cellular metabolic dysfunctions are to-day objectives for a neurochemical monitoring. Therefore a special technical and human environment has became mandatory to take a real benefit from ICP monitoring.
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Combined spinal-epidural anaesthesia (CSEA) is realized by one route immediately before the surgical procedure. It consists of: -a spinal anaesthesia for the operation itself. -followed by the installation of a catheter in the epidural space, so as to ensure postoperative analgesia. ⋯ Real contra-indications are few. Updated recent needles could certainly extend the field and general use of this technique.