BackgroundEpidural Anesthesia (EA) is a well-established procedure. The aim of the present study was to evaluate the incidence of immediate complications following epidural puncture, such as sanguineous puncture, accidental dural perforation, unsuccessful catheter placement or insufficient analgesia and to identify patient and maneuver related risk factors.MethodsA total of 7958 non-obstetrical EA were analyzed. The risk of each complication was calculated according to the preconditions and the level of puncture. For probabilistic evaluation we used a logistic regression model with forward selection.ResultsThe risk of sanguineous puncture (n = 247, 3.1%) increases with both the patient’s age (P = 0.013) and the more caudal the approach (P < 0.01). Dural perforation (n = 123, 1.6%) was found to be influenced only by advanced age (P = 0.019). Unsuccessful catheter placement (n = 68, 0.94%) occurred more often in smaller individuals (P < 0.001) and at lower lumbar sites (P < 0.01). Amongst all cases with successful catheter placement a (partial) insufficient analgesia was found in 692 cases (8.8%). This risk of insufficient analgesia decreased with patient’s age (P <0 .01), being least likely for punctures of the lower thoracic spine (P < 0.001).ConclusionsCompared to more cranial levels, EA of the lower spine is associated with an increased risk of sanguineous and unsuccessful puncture. Insufficient analgesia more often accompanies high thoracic and low lumbar approaches. The risk of a sanguineous puncture increases in elderly patients. Gender, weight and body mass index seem to have no influence on the investigated complications.

XSLT proved to be a very satisfactory technique to create different printouts and is therefore a feasible technique to enhance any AIMS. As XML turns out to be one of the most important formats for medical data, we call for the development of an international anaesthetic XML-standard and its adoption to AIMS.

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BACKGROUND: This study was conducted to evaluate the risk factors for early (within 24 hours) pulmonary embolism after meningioma surgery, focussing on the role of factor XIII. METHODS: 420 consecutive patients were enrolled in this prospective cohort study. The incidence of pulmonary embolism, activity levels and substitution of factor XIII, standard coagulation parameters, as well as surgery related parameters were monitored. RESULTS: Pulmonary embolism occurred in 33 (7.9%) cases. Patients with embolism had longer surgery (p ¼ 0.02), a higher preoperative factor XIII activity (p,0.004) or had received factor XIII substitution by the end of surgery (p,0.0001). In multivariate analysis duration of surgery, preoperative factor XIII activity as well as factor XIII substitution remained significant prognostic factors for developing pulmonary embolism. Relative risk for pulmonary embolism in patients with preoperative factor XIII activity .120% was 3.9 (95% CI 1.77-8.62), which increased to 6.4 (95% CI 3.00-13.7) in procedures lasting more than four hours. CONCLUSION: This is the first study demonstrating a strong impact of factor XIII activity on the incidence of pulmonary embolism during a specific surgical setting, thus underlining the complex interrelation of prophylactic measurements to reduce the rate of postoperative haemorrhage and pulmonary embolism after surgery.