5. Beitrag (11.01.2012)…..ursprünglich eingestellt von Nicole
Hereditary spastic paraplegia / Anesthesia
Article section 14 of 16.
By Akgun Olmez MD and Haluk Topaloglu MD
Reports on anesthetic management of hereditary spastic paraplegias are few. McTiernan and Haagenvik reported a patient presenting for an emergency Cesarean section (McTiernan and Haagenvik 1999). Regional anesthesia was considered because the patient preferred to be awake and also because of the additional risks of aspiration and succinylcholine inducing hyperkalemia in patients with paraplegia. They used fentanyl for regional block. Although no reports support their theories, it is reported that epidural anesthesia is better in patients with chronic neurologic disease because they usually have poor respiratory functions, one single shot of spinal anesthesia provides less controllable anesthesia, and potential neurotoxicity of local anesthetics would be less hazardous in epidural anesthesia. Spinal anesthesia was used in an 18-year-old patient in an emergency condition after the labor to remove the placenta manually. Fentanyl and plain bupivacaine were used without any complication (Thomas et al 2006 http://www.obstetanesthesia.com/article/S0959-289X(06)00009-4/abstract).
Another anecdotal report from Japan describes use of general anesthesia for a 39-year-old male with hereditary spastic paraplegia (Kunisawa et al 2002). They avoided muscle relaxants and narcotics and used N2O, oxygen, and sevoflurane without any complication.