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Central neurological complications following obstetric neuraxial blockade

von Peltz, Claudiaa; Bennett, Alexb; Patil, Vinoda

Current Opinion in Anesthesiology: June 2019 - Volume 32 - Issue 3 - p 315–324
doi: 10.1097/ACO.0000000000000714
OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Emilia Guasch and Manuel Wenk
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Purpose of review Central neuraxial blockade is increasingly the anaesthetic management of choice for parturients, including in higher risk pregnancies. Although they are usually effective and safe, there are potentially devastating neurological complications that may present either overtly or insidiously. A thorough understanding of the variety of potential neurological complications is essential to adequately consent patients in addition to diagnosing and managing complications following neuraxial anaesthesia. This review aims to describe a number of potential neurological injuries that may occur and suggested management based on available evidence.

Recent findings Current evidence supports neuraxial anaesthesia as a safe management strategy in low and many higher risk pregnancies, with a low overall incidence of neurological complications. Neuraxial blockade is safe in patients with platelet counts greater than 70 000/μl and the risk of infective complications secondary to epidural catheterization remains low until day five post procedure. There is also some early evidence supporting the use of transnasal local anaesthetic as a strategy for managing postdural puncture headache.

Summary Difficulty remains in establishing absolute risk of complications and optimal management strategies given the low overall number of patients affected and heterogeneity of therapy. There may be a role for centralized registration of postneuraxial complications in obstetric patients to further develop our collective understanding of these conditions.

aDepartment of Anaesthesia, Queen's Hospital, Romford

bDepartment of Intensive Care, Royal London Hospital, London, UK

Correspondence to Vinod Patil, FRCA, Department of Anesthesia, Queens Hospital, BHR University Hospital NHS Trust Romford, Romford RM7 0AG, UK. Tel: +44 1708503727; e-mail: Vinodpatiluk@gmail.com

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