Anesthetic Management of Symptomatic Chiari I Malformation in A Parturient; A Case Report
https://doi.org/1234
Keywords:
Chiari I Malformation Neuraxial Anesthesia Intracranial Pressure Obstetric Anesthesia General Anesthesia Syringomyelia Cesarean Delivery Laryngospasm Deep ExtubationAbstract:
Anesthetic management of parturients with symptomatic Chiari I malformation requires individualized assessment, as both neuraxial and general anesthesia carry theoretical risk. With regard to neuraxial anesthesia, unintentional dural puncture may produce a cerebrospinal fluid pressure gradient, which can result in further neurologic deterioration. Additionally, manipulations involved in administration of general anesthesia, including direct laryngoscopy and endotracheal intubation, without optimal medication, can result in a hypertensive response and increased intracranial pressure. We report the case of a 25-year-old parturient with a Chiari I malformation, with associated progressive neurological symptoms, and a 14-mm cerebellar tonsillar descent, who underwent cesarean delivery under general anesthesia following multidisciplinary consultation. Targeted pharmacological and hemodynamic strategies were implemented to blunt sympathetic responses during airway management. Deep extubation was complicated by laryngospasm, requiring re-sedation and re-administration of a paralytic with positive-pressure bag-mask ventilation, after which the patient was neurologically at preoperative baseline. This case illustrates the competing neuraxial and general anesthetic risks involved in managing patients with symptomatic Chiari I malformation during pregnancy.
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