Epidural in pt with nph

[foxtrot]

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Okay, in the midst of studying for my orals I came across several questions that I would like to get some professional opinions on:

1) Can you place an epidural in a patient with normal pressure hydrocephalus? (obviously you can but what if you wet tap them)

2) When you release the aortic cross clamp for a TAA repair is the increase in end tidal CO2 due to the increase in the pooled acidic (high CO2) blood to the lungs? (or is it is due to increased production or decrease in deadspace--these 2 concepts were brought up in Ho's practice exams and I wasn't sure. I didn't think increased production or deadspace had anything to do with the rise but now I am not sure).

 

[DrBrown]

#1 Yes, stolting's coexisting disease even goes as far to state that a wet tap for NPH may be therapuetic, provided there is not a mass causing increased ICP

 

[Idiopathic]

#2 maybe im just oversimplifying a more complicated concept but i always expect the rise in CO2 after release of any aortic/iliac clamp is due to the transient acidemia from the poorly perfused tissue.

i suppose that releasing whatever compromise to your ventilation was induced with the cross clamp could also attribue to the rise in ETCO2, but i think thats the zebra here

 

[DET0897]

Okay, in the midst of studying for my orals I came across several questions that I would like to get some professional opinions on:

1) Can you place an epidural in a patient with normal pressure hydrocephalus? (obviously you can but what if you wet tap them)

quote]

We routinely drain 30cc or so of CSF in patients with NPH to compare before/after results on mobility tests to see if they would respond to shunt placement, so a little wet tap action is no problem.

Not sure what the other post was getting at with increased ICP with mass since that would be unrelated to NPH.

That said, even with increased ICP, a wet tap wont hurt you if it there is communication along the CSF flow tract, as no pressure gradient will occur and nothing can herniate. I have often perform therapeutic taps in patients with pseudotumor cerebri and SAH with increased ICP .

If a mass caused blockage of CSF flow and therefore a pressure gradient exists, then a wet tap could be bad, but again, that wouldn't be NPH.