[The anesthetic management of Arnold-Chiari malformation with spinal cord injury].
A rare case of spinal cord injury at C3 level associated with Arnold-Chiari malformation is reported. A 33 year old male was admitted with a complaint of walking difficulty. MRI revealed cerebellar herniation, and a plain X-ray showed spinous process adhesion of C2-3 and slight scoliosis. Percent vital capacity was reduced to 69%, and blood cell count showed a slight anemia. The patient was anesthetized for an orthopedic surgery with pethidine 70 mg, thiamylal 200 mg, 60% nitrous oxide, 40% oxide, and 0.5-1.2% isoflurane. There was a mild decrease in arterial blood pressure during surgical procedures, but this could be easily treated by fluid therapy, and there was no episode of autonomic hyperreflexia. Postoperative course of the patient was uneventful, except a transient pneumonia and urinary tract infection. The key in the anesthetic management of Arnold-Chiari malformation with spinal cord injury is the control of intracranial pressure, care for respiratory dysfunction and the prevention of infection as well as autonomic hyperreflexia.
Saitoh
Y
Y
Department of Anesthesiology and Critical Care Medicine, Tokyo Medical and Dental University School of Medicine.
Ohshima
T
T
Ichikawa
K
K
Makita
K
K
Masuda
A
A
Toyooka
H
H
D000328:Adult; D000758:Anesthesia / Q000379:methods*; D001139:Arnold-Chiari Malformation / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D009985:Orthopedics; D013119:Spinal Cord Injuries / Q000150:complications* / Q000601:surgery