Listen,
My point is not invalid, actually I can assure you that the majority of practicing anesthesiologists would agree with me and would not do neuraxial anesthesia on someone with chiari malformation.
Your input was completely out of context and irrelevant, and let me tell something about the effect of volume injected in the epidural space on ICP:
When I do blood patches on patients who had epidural injections by people like you the headache disappears after 15 - 20 CC, this means the ICP had increased, can you grasp this concept?
We deal with a patient population you are not familiar with under conditions beyond your level of expertise.
One more thing, No one asked you why you became a glorified physical therapist and not an anesthesiologist so you didn't really need to tell us your life story.
I perform epidural procedures including adhesiolyis with either Myelotec or EBI-Target catheters several times per year. In patients with Chiari I and post laminectomy syndrome, I have yet to see a CSF leak or neurological compromise. My N=3 or 4. Many Chairi I patients are undiagnosed and asymptomatic. So with my tiny N and no issues, I'm awaiting a response by somebody who has had compromise or who can postulate a reasonable argument that entering the epidural space in these patients can be more dangerous than in the general population.
PUBMED is your friend:
Beverly J. Newhouse1 and Krzysztof M. Kuczkowski1
(1) Department of Anesthesiology, UCSD Medical Center, 200 W. Arbor Drive, San Diego, CA 92103-8770, USA
Received: 4 July 2006 Accepted: 15 July 2006 Published online: 16 August 2006
Abstract Arnold-Chiari malformation is a disorder of the hindbrain which can lead to altered craniospinal pressures and abnormal flow of cerebrospinal fluid. The possibility of increased intracranial pressure imparts significant risk during labor and delivery, and has led to concern over the use of neuraxial anesthesia. Sickle cell disease is a disorder of abnormal hemoglobin that is prone to sickling under stressful conditions. The physiologic and metabolic changes associated with pregnancy and labor can precipitate sickling, which increases risks for both the mother and the fetus. Vaso-occlusive pain crisis in a parturient with sickle cell disease has been shown to improve with the initiation of neuraxial anesthesia. We present the first reported case of a parturient with both Arnold-Chiari malformation type I and sickle cell disease who presented to labor and delivery with acute pain crisis and who subsequently received epidural labor analgesia and underwent successful vaginal delivery. We include a discussion of the risks associated with pregnancy, labor, neuraxial anesthesia, and delivery in a patient with Arnold-Chiari malformation type I and sickle cell disease.
Thanks for the insult. I guess you are always right.
Please reference the increased ICP after blood patch. I would agree that ICP increases, but only to reach baseline. Normal range 80-180 mmH2O, so with PDPH is the pressure 40? If you perform a blood patch does the pressure then exceed 180?
Let me bask in the glory of your knowledge.
COLOR="Red"]The debasing of your character is an unpleasant way of presenting yourself in an open forum. Stick to the facts and the case, I am certain you are a much finer person than I am; probably richer, taller, happier, and providing a higher standard of care for your patients and the country than I could provide. I have nothing bad to say, but thanks for the personal attack on my profession, skill, character, and intelligence. I must now travel to NJ to cry on my mothers shoulder.[/COLOR}
1 Sicuranza GB, Steinberg T, Figueroa R. Arnold-Chiari malformation in a pregnant woman. Obstet Gynecol 2003; 102 (5 Pt 2): 11914.[Abstract/Free Full Text]
2 Heiss JD, Patrons N, DeVroom HT, et al. Elucidating the pathophysiology of syringomyelia. J Neurosurg 1999; 91: 55362.[Medline]
3 Semple DA, McClure JH. Arnold-Chiari malformation in pregnancy. Anaesthesia 1996; 51: 5802.[Medline]
4 Landau R, Giraud R, Delrue V, Kern C. Spinal anesthesia for cesarean delivery in a woman with a surgically corrected type I Arnold Chiari malformation. Anesth Analg 2003; 97: 2535.[Abstract/Free Full Text]
5 Hullander RM, Bogard TD, Leivers D, Moran D, Dewan DM. Chiari I malformation presenting as recurrent spinal headache. Anesth Analg 1992; 75: 10256.[Free Full Text]
Now I have to get back to work creating more patients who require blood patches.....