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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2014 September;80(9):1030-45
Neuraxial anesthesia in patients with intracranial hypertension or cerebrospinal fluid shunting systems: what should the anesthetist know?
Guerci P. 1, Vial F. 1, McNelis U. 2, Losser M.-R. 3, Raft J. 4, Klein O. 5, Iohom G. 6, Audibert G. 7, Bouaziz H. 1, 7 ✉
1 Department of Anesthesiology, Maternity Hospital, University Hospital of Nancy, Nancy, France;
2 Department of Anesthesiology, Wansbeck General Hospital, Ashington, UK;
3 Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy-Brabois, Nancy-Brabois, France;
4 Department of Anesthesiology, Institut de Cancérologie de Lorraine-Alexis Vautrin, Vandoeuvre-Lès-Nancy, France;
5 Department of Neurosurgery, University Hospital of Nancy, Nancy, France;
6 Department of Anesthesiology and Intensive Care Medicine, Cork University Hospital, Ireland;
7 Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Nancy, France
The management of patients with central nervous system disorders such as brain tumours, hydrocephalus, intracranial hypertension, or subarachnoid hemorrhage has improved in recent years resulting in increased life expectancy. Consequently, the prevalence of patients with increased intracranial pressure or cerebrospinal fluid shunting devices presenting for non-neurological procedures has increased. These patients commonly receive a general anesthetic, as the safety profile of neuraxial anesthesia in this clinical setting remains uncertain. This article reviews literature on neuraxial anesthesia in patients with intracranial hypertension or cerebrospinal fluid shunting systems. It describes current knowledge, exposes and weighs the real benefits and risks of this technique in this setting. It provides several scenarios and anesthetic options to help the practitioner with choosing a tailored approach in this specific population.