Postpunkční cefalea · 75 mg nebo paracetamol 500 mg + kofein 125 mg) není prevencí PDPH. J...

POSTPUNKČNIacute CEFALEA

Dušan Mach

Kongres ČSARIM Praha 2016

BOLESTI HLAVY A ANESTEZIOLOG

Hypovolemickeacute bolesti

Cofeinovaacute abstinence

Migreacutena

Pneumocefalus

Subduraacutelniacute intrakraniaacutelniacute hematom

Meningitida

Trombosa venosniacuteho sinu

Postpunkčniacute cefalea

PATOFYZIOLOGIE PDPH

Bier a Hildebrand - 1896

Uacutenik CSF punkčniacutem otvorem a naacutesledneacute změny

tlaku v subarachnoidaacutelniacutem prostoru

Polohoveacute změny mozku tah za nervoveacute a ceacutevniacute

struktury (zvlaacuteště vsedě)

Naacutezor na mechanismus se dodnes nezměnil

SYMPTOMATOLOGIE

Bolest hlavy (tah za hlavoveacute nervy V X XI)

Diplopie (hlavoveacute nervy IV VI)

Meningismus bolesti šiacutejoveacuteho svalstva

Ztraacuteta sluchu (praacuteh 10dB)

PDPH V PORODNICTVIacute

Vyššiacute incidence - 2-10 po SA

Po naacutehodneacute punkci epiduraacutelniacute jehlou 50-80

vysokaacute intenzita vedouciacute k imobilizaci

Použitiacute CSE CSA

FAKTORY OVLIVŇUJIacuteCIacute INCIDENCI

Kalibr jehly a tvar hrotu

Směr jehly a orientace hrotu

Pohlaviacute

PREVENCE UacuteNIKU CSF

Použitiacute tenkyacutech jehel

Speciaacutelniacute hroty ndash atraucan pencil pointhellip

Použitiacute paramediaacutelniacuteho přiacutestupu

Ne - mnohočetneacute pokusy

Fig 1 Graphical representations of epidural (needle 4) and spinal needle tip design

D K Turnbull and D B Shepherd Br J Anaesth

200391718-729

MOŽNOSTI TERAPIE

1 Snaha o prevenci ndash režimovou farmakologickou

preventivniacute EDBP (krevniacute zaacuteplata)

2 Konzervativniacute ndash klid na lůžku zvyacutešit přiacutejem

tekutin farmakoterapie

3 Invazivniacute terapie ndash EDBP (krevniacute zaacuteplata)

UacutePRAVA PDPH BEZ TERAPIE

PREVENCE PDPH PO PUNKCI

Neexistuje žaacutednyacute důkaz kteryacute by podporoval

prospěšnost klidu na lůžku Role přiacutejmu tekutin v

prevenci PDPH je zcela nejasnaacute

Cochrane Database Syst Rev 2002(2) CD001790 L

Posture and fluids for preventing post-dural

puncture headache

Sudlow C Warlow C Department of Clinical

Neurosciences Western General Hospital Crewe

Road Edinburgh UK EH4 Kongres ČSARIM Praha 2016

Paracetamol + kofein (paracetamol 500 mg + kofein

75 mg nebo paracetamol 500 mg + kofein 125 mg)

neniacute prevenciacute PDPH

J Clin Anesth 2005 Feb17(1)58-61

Oral multidose caffeine-paracetamol

combination is not effective for the prophylaxis

of postdural puncture headache

Esmaoglu A Akpinar H Uğur F

Department of Anesthesia University of Erciyes

Kayseri Turkey Kongres ČSARIM Praha 2016

64 rodiček s nechtěnou punkciacute dury Polovina

dostala profylaktickyacute EDBP polovina ne U obou

skupin se vyvinula PDPH v 56 u obou byla stejnaacute

potřeba pro terapeutickyacute EDBP

Anesthesiology 2004 Dec101(6)1422-7

Efficacy of a prophylactic epidural blood patch in preventing post

dural puncture headache in parturients after inadvertent dural

puncture

Scavone BM Wong CA Sullivan JT Yaghmour E Sherwani SS

McCarthy RJ Department of Anesthesiology Northwestern University

Feinberg School of Medicine Chicago USA

TERAPIE ROZVINUTEacute PDPH

Symptomatickaacute - klid na lůžku cofein sumatriptan

paracetamol

Zvyacutešeniacute tvorby CSF ndash tekutiny aminophyllin

Zvyacutešeniacute epiduraacutelniacuteho tlaku - koloidy albumin

epiduraacutelně břišniacute bandaacutež

Mechanickaacute obturace - krevniacute zaacuteplata

Abdominaacutelniacute bandaacutež ndash riziko TEN

FARMAKOTERAPIE

Paracetamol

Opiaacutety (epiduraacutelně 3mg)

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

EDBP ndash KREVNIacute ZAacutePLATA

Uacutespěch 68-90 (97 - druhyacute pokus)

Uacutespěšnost roste po 24 hodinaacutech

2 mechanismy -tlakoveacute změny v EP

-zalepeniacute otvoru

Objem dop 5-20ml (10-15ml)

Alternativa ndash dextran (Jehovaacutes witness)

DĚKUJI ZA POZORNOST

Migreacutena

Pneumocefalus

Meningitida

PATOFYZIOLOGIE PDPH

SYMPTOMATOLOGIE

Pohlaviacute

200391718-729

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

Migreacutena

Pneumocefalus

Meningitida

PATOFYZIOLOGIE PDPH

SYMPTOMATOLOGIE

Pohlaviacute

200391718-729

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

PATOFYZIOLOGIE PDPH

SYMPTOMATOLOGIE

Pohlaviacute

200391718-729

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

SYMPTOMATOLOGIE

Pohlaviacute

200391718-729

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

SYMPTOMATOLOGIE

Pohlaviacute

200391718-729

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

Pohlaviacute

200391718-729

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

Pohlaviacute

200391718-729

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

Pohlaviacute

200391718-729

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

200391718-729

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

200391718-729

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

MOŽNOSTI TERAPIE

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

puncture headache

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

puncture

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

paracetamol

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

FARMAKOTERAPIE

Paracetamol

Kofein ( 75-500mg)

Hydrokortison

Triptany

Gabapentin

Synacten (ACTH)

Postpunkční cefalea · 75 mg nebo paracetamol 500 mg + kofein 125 mg) není prevencí PDPH. J...

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