Regional Anesthesia for Chronic Disease States
Historically, the use of regional anesthetic techniques in patients with preexisting central nervous system (CNS) disorders has been considered relatively contraindicated. Probably, the most conservative legal approach in these patients is to avoid regional anesthesia. The recommendations of Vandam and Dripps in 1956 were to avoid spinal anesthesia in patients with preexisting CNS disorders, and these recommendations have greatly influenced the clinical management of these patients for the last several decades. The cause of postoperative neurological disorders is multifactorial and is usually difficult to evaluate because of the many patients and surgical and anesthetic risk factors that may play a role, Table 21.1 . Therefore, the abundance of contributing factors makes it extremely difficult for clinicians and investigators alike to reliably isolate the effect of anesthetic technique on neurologic outcome.
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