AV malformation and Spinals

[s204367]

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31 week pregnant woman with twins comes in in Labor at 4cm with a previous history of of an intracranial AV malformation repair 4 years ago. Hx of previous C/S and myoma repaired with long uterine incision....going to the OR urgently for C/S. Spinal or General??? she is thin, likely easy spinal, likely easy tube. No other history about her is known.....

 

[Laryngospasm]

31 week pregnant woman with twins comes in in Labor at 4cm with a previous history of of an intracranial AV malformation repair 4 years ago. Hx of previous C/S and myoma repaired with long uterine incision....going to the OR urgently for C/S. Spinal or General??? she is thin, likely easy spinal, likely easy tube. No other history about her is known.....

MAC

 

[militarymd]

local

 

[ReefTiger]

So, I hear this response sometimes- "have them do it under local".

I've never seen an OB do this, nor do I even know what I should do from an anesthesia standpoint for a c/s under local. Could someone please tell me? Also, when should I dictate that they have to do it under local?

 

[apma77]

no increased ICP issues or coagulopathy= spinal in this patient

So, I hear this response sometimes- "have them do it under local".

I've never seen an OB do this, nor do I even know what I should do from an anesthesia standpoint for a c/s under local. Could someone please tell me? Also, when should I dictate that they have to do it under local?

 

[jetproppilot]

31 week pregnant woman with twins comes in in Labor at 4cm with a previous history of of an intracranial AV malformation repair 4 years ago. Hx of previous C/S and myoma repaired with long uterine incision....going to the OR urgently for C/S. Spinal or General??? she is thin, likely easy spinal, likely easy tube. No other history about her is known.....

The AVM shouldnt be a factor in your decision process since its been "repaired".

If you've got time, do a spinal.

If not, put her to sleep.

 

[s204367]

There is an association between intracranial AV malformations and dural AV malformations..these can be anywhere along the dura .the association is low...about .2% from what I have read, though there is not a lot of papers on this. however you don't really know unless you have an MRI. No issues regarding ICP at all, even if the AVM had not been repaired.....I did the spinal, knowing of the association, and one of my partners tried giving me a load of crap.....0.2% association, would have to be at the L4/5 space on top of that, extremely slim chances of hitting one...now an epidural I would not have done without knowing the results of an MRI. I would say though, there was really no contrindication to a general, and she would have been an easy intubation.......