Anesthetic management of parturients with Arnold Chiari malformation-I: a multicenter retrospective study |
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| Affiliation: | 1. Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States;2. Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States;3. Department of Anesthesiology, Icahn School of Medicine, Mount Sinai West Hospital, New York, NY, United States;4. Department of Anesthesiology, Duke University Hospital, Durham, NC, United States;5. Department of Anesthesiology, Rush University Medical Center, Chicago, IL, United States;1. Hôpital La Conception, Department of Gynecology and Obstetrics, 147, boulevard Baille, 13385 Marseille cedex 5, France;2. Children''s Hospital La Timone, Multidisciplinary Center for Prenatal Diagnosis, 264, rue Saint-Pierre, 13385 Marseille cedex, France;3. Department of Gynecology and Obstetrics, 305, rue Raoul-Follereau, 84902 Avignon, France;4. Children''s Hospital La Timone, Department of Pediatric Surgery, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France;5. Hôpital Nord, Department of Gynecology and Obstetrics, chemin des Bourrely, 13015 Marseille, France;6. Children''s Hospital La Timone, Department of Pediatric Oncology, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France;7. Chidren''s Hospital La Timone, Department of Neurosurgery, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France;8. Children''s Hospital La Timone, Department of Pediatric Imaging, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France |
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| Abstract: | BackgroundConsensus regarding the safest mode of delivery and anesthetic management for parturients with Arnold Chiari malformation-I (ACM-I) remains controversial. This study assessed their anesthetic management and reported anesthetic complications during hospitalization for delivery.MethodsThis was a multicenter, retrospective, cohort study of patients with ACM-I undergoing vaginal or cesarean delivery. Data were obtained from the electronic databases of four United States academic institutions using International Classification of Diseases (ICD) codes from 2007–2017 at three sites and 2004–2017 at one site. The primary outcome was anesthetic complications.ResultsData were analyzed for 185 deliveries in 148 patients. Diagnosis of ACM-I was made prior to delivery in 147 (80%) cases. Pre-delivery neurosurgical consultation for management of ACM-I was performed in 53 (36%) patients. Pre-existing symptoms were recorded for 89 (48%) of the deliveries. Vaginal deliveries occurred in 80 (43%) cases, and 62 women (78%) received neuraxial labor analgesia. Cesarean delivery was performed in 105 (57%) cases, of which 70 women (67%) had neuraxial anesthesia and 34 (32%) received general anesthesia. Post-dural puncture headache was reported in three (2%) patients who had neuraxial anesthesia, and in two (12%) patients with syringomyelia. There was one (3%) reported case of aspiration pneumonia with general anesthesia.ConclusionsThe findings suggest that anesthetic complications occur infrequently in patients with ACM-I regardless of the anesthetic management. Although institutional preference in anesthetic and obstetric care appears to drive patient management, the findings suggest that an individualized approach has favorable outcomes in this population. |
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| Keywords: | Anesthesia Obstetric Neuraxial General anesthesia Arnold Chiari malformation Multicenter Retrospective |
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