Obstetric and anesthetic management in parturients with ventriculoperitoneal shunt: a case series.

IF 2.8 3区 医学 Q2 ANESTHESIOLOGY
Journal of Anesthesia Pub Date : 2024-10-01 Epub Date: 2024-07-01 DOI:10.1007/s00540-024-03369-7
Ashley A Wehrle, Tasha L Welch, Ingrid L Hirte, Jeffrey J Pasternak, Emily E Sharpe
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Abstract

Further study is needed to determine the safest mode of delivery and anesthetic management for parturients with ventriculoperitoneal shunts (VP). Prior recommendation for delivery in women with ventriculoperitoneal shunts was cesarean delivery. However, both vaginal delivery and neuraxial anesthesia have been shown to be safe in women with appropriately functioning VP shunts. We present a case series of parturients with VP shunt. Parturients with VP shunts were identified and VP shunt placement indications, neurologic symptoms during pregnancy, delivery mode, anesthetic type, and postpartum complications were reviewed. Forty patients were identified, and fifteen women with twenty deliveries were included. Two women experienced neurological symptoms during pregnancy and one required postpartum shunt revision for blurry vision and ataxia. There were ten cesarean deliveries and ten vaginal deliveries (eight normal spontaneous, one vacuum assisted, and one forceps assisted). Assisted vaginal deliveries were performed to decrease Valsalva including the patient with neurological symptoms related to shunt malfunction. Of the vaginal deliveries, six (60%) had epidural analgesia. Anesthesia for cesarean delivery included neuraxial anesthesia (n = 5) and general anesthesia (n = 5). In our cohort, women with VP shunt received neuraxial blockade without complication. Neuraxial techniques should be offered to women with appropriately functioning VP shunt.

Abstract Image

脑室腹腔分流术产妇的产科和麻醉管理:病例系列。
需要进一步研究确定脑室腹腔分流术(VP)产妇最安全的分娩方式和麻醉管理。之前对患有脑室腹腔分流术的产妇的分娩方式建议是剖宫产。然而,对于脑室腹腔分流功能正常的产妇来说,阴道分娩和神经麻醉都已被证明是安全的。我们介绍了一系列患有 VP 分流的产妇病例。我们对患有 VP 分流术的产妇进行了鉴定,并回顾了 VP 分流术的适应症、孕期神经症状、分娩方式、麻醉类型和产后并发症。共确定了 40 名患者,其中 15 名产妇共分娩了 20 次。两名产妇在孕期出现了神经系统症状,一名产妇因视力模糊和共济失调而需要进行产后分流术修正。其中有 10 例剖宫产和 10 例阴道分娩(8 例正常自然分娩、1 例真空助产和 1 例产钳助产)。进行阴道助产是为了减少 Valsalva,包括分流器故障导致神经症状的患者。在阴道分娩中,有六例(60%)进行了硬膜外镇痛。剖宫产麻醉包括神经麻醉(5 例)和全身麻醉(5 例)。在我们的队列中,有VP分流的产妇接受了神经阻滞,没有发生并发症。神经阻滞技术应提供给VP分流功能正常的产妇。
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来源期刊
Journal of Anesthesia
Journal of Anesthesia 医学-麻醉学
CiteScore
5.30
自引率
7.10%
发文量
112
审稿时长
3-8 weeks
期刊介绍: The Journal of Anesthesia is the official journal of the Japanese Society of Anesthesiologists. This journal publishes original articles, review articles, special articles, clinical reports, short communications, letters to the editor, and book and multimedia reviews. The editors welcome the submission of manuscripts devoted to anesthesia and related topics from any country of the world. Membership in the Society is not a prerequisite. The Journal of Anesthesia (JA) welcomes case reports that show unique cases in perioperative medicine, intensive care, emergency medicine, and pain management.
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