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Lawrence H, Morton A. Postpartum complications following neuraxial anaesthesia for obstetric physicians. Obstet Med 2023; 16:142-150. [PMID: 37720002 PMCID: PMC10504890 DOI: 10.1177/1753495x221146329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/04/2022] [Indexed: 09/19/2023] Open
Abstract
Neuraxial analgesia and anaesthesia are widely accepted and well-tolerated modes of delivery analgesia, being employed in up to 76% of vaginal deliveries and 94% of caesarean deliveries in the United States.1 A cause of considerable concern for postpartum women, their family and caring health professionals is the occurrence of unexplained postpartum complications, not only for management in the index pregnancy, but the uncertain risk of recurrence in future pregnancies. Complications of neuraxial blocks may impact significantly on the ability of mothers to care for and bond with their newborn. The reported incidence of temporary neurological deficit following obstetric neuraxial blocks is 1 in 3900 procedures, and the risk of permanent neurological harm estimated to be between 1 in 80,000 and 1 in 320,425 procedures.2 Obstetric physicians may be asked to review women with postpartum complications following neuraxial blocks. This article reviews complications that may be seen following neuraxial blocks for delivery.
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Affiliation(s)
- Heather Lawrence
- Obstetrics Department, Mater Health, Raymond Terrace, South Brisbane, Australia
| | - Adam Morton
- Obstetric Medicine, Mater Health, Raymond Terrace, South Brisbane, Australia
- Department of Medicine, University of Queensland, Herston, Australia
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Horner's Syndrome and Lymphocele Following Thyroid Surgery. J Clin Med 2023; 12:jcm12020474. [PMID: 36675400 PMCID: PMC9865845 DOI: 10.3390/jcm12020474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid−related HS represents an unusual entity underling thyroid nodules/goiter/cancer−HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2−6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients.
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Silva L, Junqueira AF, Pato R, Farraposo S, Cruz AR, Rocha T. Horner's Syndrome as a Complication of Ultrasound-Guided Central Cannulation: A Case Report. Cureus 2022; 14:e28700. [PMID: 36204040 PMCID: PMC9527068 DOI: 10.7759/cureus.28700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/05/2022] Open
Abstract
Cannulation of the internal jugular vein is often necessary for the management of critically ill patients. Despite being a very common procedure and performed more and more safely, several complications still occur. Horner's Syndrome (HS) is one of those complications described before the use of ultrasound as a method of guidance. HS is caused by functional interruption of sympathetic nerve supply to the eye, leading to a classic triad of ipsilateral ptosis, miosis, and anhidrosis. We present the case of a patient, in need of emergent surgery to control the hemorrhagic focus after delivery, with a transient HS secondary to internal jugular vein cannulation under real-time ultrasound guidance.
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Holck G, Quaye AN. Alternating bilateral Horner's syndrome during continuous thoracic epidural analgesia. Anaesth Rep 2022; 10:e12147. [PMID: 35156044 PMCID: PMC8818827 DOI: 10.1002/anr3.12147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- G. Holck
- Department of Anesthesiology and Perioperative MedicineMaine Medical CenterPortlandMEUSA
| | - A. N. Quaye
- Department of AnesthesiologySpectrum Healthcare PartnersSouth PortlandMEUSA
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Moss HE. Neuro-ophthalmology and Pregnancy. Continuum (Minneap Minn) 2022; 28:147-161. [PMID: 35133315 PMCID: PMC9159902 DOI: 10.1212/con.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW This article summarizes the impact of pregnancy on neuro-ophthalmic pathways and presents an approach to the evaluation of pregnant women who have neuro-ophthalmic symptoms or signs. RECENT FINDINGS Advances in noninvasive ophthalmic imaging have increased knowledge of the impact of pregnancy on ocular blood flow, which may have relevance for understanding the impact of preeclampsia and eclampsia on the eye. SUMMARY The framework for approaching neuro-ophthalmic symptoms and signs in pregnant women is similar to the general approach for people who are not pregnant. Visual symptoms are common in preeclampsia and eclampsia. Some diseases that impact the neuro-ophthalmic pathways are more common in pregnant women. Pregnancy should be considered when recommending the workup and treatment for neuro-ophthalmic symptoms and signs.
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Crisóstomo J, Dias C, Pedro D, Pires R, Rocha T. Horner's Syndrome and Upper Limb Paresthesia During Labor Epidural Analgesia: A Case Report. Cureus 2022; 14:e21388. [PMID: 35070588 PMCID: PMC8765805 DOI: 10.7759/cureus.21388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
Horner's syndrome is a condition that results from sympathetic nervous system dysfunction. Labor epidural analgesia is known to be a rare cause of Horner's Syndrome. However, in the obstetric population, the incidence of Horner's Syndrome is higher than in the rest of the population as it is a consequence of high cephalad spread of local anesthetic (LA) probably enhanced by the anatmophysiologic changes of pregnancy. We present a case of unilateral Horner's syndrome as a complication of epidural analgesia with accompanying upper limb paresthesia and motor weakness, a rarely encountered symptom.
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Affiliation(s)
- João Crisóstomo
- Anesthesiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, PRT
| | - Carolina Dias
- Anesthesiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, PRT
| | - Daniel Pedro
- Anesthesiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, PRT
| | - Rafael Pires
- Anesthesiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, PRT
| | - Teresa Rocha
- Anesthesiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, PRT
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Bianchi C, Stathopoulou TR. Transient unilateral Horner's syndrome after epidural catheter administration of bupivacaine in a dog. Vet Anaesth Analg 2021; 48:628-629. [PMID: 34099395 DOI: 10.1016/j.vaa.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/01/2021] [Accepted: 03/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Cristina Bianchi
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK.
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Li J, Guo W, Zhao W, Wang X, Hu W, Zhou J, Xu S, Lei H. Ultrasound-Guided Unilateral Transversus Abdominis Plane Combined with Rectus Sheath Block versus Subarachnoid Anesthesia in Patients Undergoing Peritoneal Dialysis Catheter Surgery: A Randomized Prospective Controlled Trial. J Pain Res 2020; 13:2279-2287. [PMID: 32982391 PMCID: PMC7500835 DOI: 10.2147/jpr.s264255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
Background Peritoneal dialysis catheter placement can be performed under general anesthesia, local anesthesia or subarachnoid anesthesia (SA). Recently, studies have reported the successful placement of peritoneal dialysis catheters using a transversus abdominis plane (TAP) block and rectus sheath (RS) block. This study compared the TAP + RS block with SA for patients undergoing peritoneal dialysis catheter placement. Methods Sixty patients were randomly divided into two groups, with 30 receiving unilateral ultrasound-guided TAP + RS block anesthesia and 30 receiving SA. The demographic characteristics, anesthesia efficacy, indicators related to anesthesia or operation, hemodynamic index, postoperative pain numeric rating score (NRS), postoperative recovery indicators, complications related to anesthesia or surgery, and dosage of sedative or analgesic medication were analyzed. Results Anesthesia operation time was significantly shorter in the TAP + RS block group than in the SA group (P<0.001), while there was no significant difference in success rates (TAP + RS 93.33% [95% confidence interval, 95% CI, 83.9–102.8%] vs SA 100.00% [95% CI, 100–100%], P=0.472). Two patients in the TAP + RS group needed extra analgesia, although the dermatome pinprick sensation test gave negative results for all patients. Patients who received the TAP + RS block expressed significantly less pain on movement or at rest at 4 h and 8 h postoperative. Fewer patients needed rescue analgesia with tramadol in the postoperative period in the TAP + RS block group than in the SA group (P<0.05). The intraoperative MAP was more stable (P<0.05) in the TAP + RS group compared to the SA group. Conclusion The TAP + RS block is a safe, effective method for use as the principal anesthesia technique in PD catheter placement. Compared to SA, it has the advantages of less influence on hemodynamics and a better postoperative analgesic effect.
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Affiliation(s)
- Ji Li
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wenjing Guo
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wei Zhao
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xiang Wang
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Wenmin Hu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Jie Zhou
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shiyuan Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Hongyi Lei
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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Barghouthi T, Lemley R, Figurelle M, Bushnell C. Epidemiology of neurologic disease in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:119-141. [PMID: 32736746 DOI: 10.1016/b978-0-444-64239-4.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many neurologic diseases in women are influenced by the physiologic and hormonal changes of pregnancy, and pregnancy itself poses challenges in both treatment and evaluation of these conditions. Some diseases, such as epilepsy and multiple sclerosis, have a high enough prevalence in the young female population to support robust epidemiologic data while many other neurologic diseases, such as specific myopathies and muscular dystrophies, have a low prevalence, with data limited to case reports and small case series. This chapter features epidemiologic information regarding a breadth of neurologic conditions, including stroke, epilepsy, demyelinating disease, peripheral neuropathies, migraine, sleep-disordered breathing, and meningioma, in women in the preconception, pregnancy, and postpartum stages.
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Affiliation(s)
- Tamara Barghouthi
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Regan Lemley
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Morgan Figurelle
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Cheryl Bushnell
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States.
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Abstract
INTRODUCTION Horner's syndrome is an unusual side effect of epidural analgesia. We report an unusual symptom after epineural axis analgesia for labor, which happened three times in the same patient. Horner's syndrome occurrence following epidural catheterization should lead the anesthetic team to search for a subdural position of the catheter because of its potentially threatening complications. PATIENT'S CONCERN Our patient, a 38 years old pregnant woman, was managed by the anesthetic team for the analgesia of her second labor. Anesthetic consultation pointed out that she had a history of Horner's syndrome after epidural analgesia attempt during her first pregnancy.During our anesthetic management of her second labor, she presented, on the left side of the body, with the same symptom as she had during her first labor a few years ago, associated with high unilateral sensory block after epidural catheterization. After the total regression of neurological signs, a second catheterization attempt was followed by a contralateral isolated Horner's syndrome with no sensory block. DIAGNOSIS A few minutes after the induction of analgesia, our patient presented left ptosis, meiosis, and enophthalmos associated with a high homolateral sensory block. The subdural catheter position was suspected, and the catheter was removed. INTERVENTION Because of this repeated unusual complication and because we would not have used the catheter for an emergency C section, we chose to remove it definitively. OUTCOME Our patient had a total regression of the symptoms 1 h after the catheter withdrawal. Delivery was rapid, with no complications, and she was discharged from the hospital 3 days after. CONCLUSION Our observations suggest the possibility of a potential anatomical particularity of the dural canal in this patient and question the safety of performing an epidural catheterization for further procedures.
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Affiliation(s)
- Caroline Turbelin
- Department of Anesthesiology and Critical Care Medicine, CH Lens, Lens, France
| | - Jihad Mallat
- Department of Anesthesiology and Critical Care Medicine, CH Lens, Lens, France
- Department of Critical Care Medicine, Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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Bennett RJ, Wooten A, Babbel L, Reel BA. Horner’s Syndrome with Unilateral Brachial Plexus Blockade Mimicking Cerebrovascular Accident Following Lumbar Combined Spinal Epidural Analgesia for Labor. Mil Med 2019; 185:e322-e323. [DOI: 10.1093/milmed/usz160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/31/2019] [Indexed: 11/15/2022] Open
Abstract
Abstract
Horner’s Syndrome (HS) with brachial plexus involvement following lumbar epidural anesthesia may be a startling event for the patient and providers. We present a case of Horner’s Syndrome and complete brachial plexus blockade following epidural bolus of lidocaine for labor analgesia that was initially misdiagnosed as a cerebrovascular accident. Use of the catheter was discontinued and the episode resolved with expectant management. This complication is otherwise benign and resolves without sequelae.
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Affiliation(s)
- Richard J Bennett
- Department of Anesthesia, San Antonio Uniformed Service Health Education Consortium, 3551 Roger Brooke Drive, San Antonio, TX
| | - Amy Wooten
- Department of Anesthesia, San Antonio Uniformed Service Health Education Consortium, 3551 Roger Brooke Drive, San Antonio, TX
| | - Lee Babbel
- Department of Anesthesia, San Antonio Uniformed Service Health Education Consortium, 3551 Roger Brooke Drive, San Antonio, TX
| | - Bradley A Reel
- Department of Anesthesia, San Antonio Uniformed Service Health Education Consortium, 3551 Roger Brooke Drive, San Antonio, TX
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Bouvet L, Chassard D. Which anesthetic technique should be used for cesarean section in the case of Horner's syndrome associated with epidural analgesia in labor? Int J Obstet Anesth 2019; 38:148-149. [PMID: 30879934 DOI: 10.1016/j.ijoa.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 11/18/2022]
Affiliation(s)
- L Bouvet
- Service d'anesthésie réanimation, Hôpital femme mère enfant, Bron, France
| | - D Chassard
- Service d'anesthésie réanimation, Hôpital femme mère enfant, Bron, France; Université de Lyon, Lyon, France.
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Chambers DJ, Bhatia K. In reply: Which anaesthesia for cesarean section in case of Horner's syndrome in women receiving epidural labor analgesia? Int J Obstet Anesth 2019; 38:149. [PMID: 30878173 DOI: 10.1016/j.ijoa.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 11/17/2022]
Affiliation(s)
- D J Chambers
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - K Bhatia
- Manchester University Hospital NHS Foundation Trust, St Mary's Hospital, Manchester, United Kingdom.
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Abstract
PURPOSE OF REVIEW Central neuraxial blockade is increasingly the anaesthetic management of choice for parturients, including in higher risk pregnancies. Although they are usually effective and safe, there are potentially devastating neurological complications that may present either overtly or insidiously. A thorough understanding of the variety of potential neurological complications is essential to adequately consent patients in addition to diagnosing and managing complications following neuraxial anaesthesia. This review aims to describe a number of potential neurological injuries that may occur and suggested management based on available evidence. RECENT FINDINGS Current evidence supports neuraxial anaesthesia as a safe management strategy in low and many higher risk pregnancies, with a low overall incidence of neurological complications. Neuraxial blockade is safe in patients with platelet counts greater than 70 000/μl and the risk of infective complications secondary to epidural catheterization remains low until day five post procedure. There is also some early evidence supporting the use of transnasal local anaesthetic as a strategy for managing postdural puncture headache. SUMMARY Difficulty remains in establishing absolute risk of complications and optimal management strategies given the low overall number of patients affected and heterogeneity of therapy. There may be a role for centralized registration of postneuraxial complications in obstetric patients to further develop our collective understanding of these conditions.
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