CorrespondenceWe read with interest the report by Shields et al. on the management of cerebrospinal fluid (CSF) leak after accidental dural puncture, as we have recently managed a similar case [1]. An epidural was inserted at L3-4 for labour analgesia in a 32-year-old parturient, however, this was ineffective. A second epidural attempt at the same level 10 h later was complicated by accidental dural puncture. A catheter was threaded 4 cm intrathecally and used for labour analgesia for 6 h until delivery. Over the following 24 h, the patient developed a significant postural headache and leakage of CSF from the site of the epidural attempts.With consent, an epidural blood patch was performed under sterile aseptic conditions and 20 ml of autologous blood was injected into the epidural space at L3-4 with the patient in the left lateral position. The headache resolved within 4 h and no further fluid leakage occurred. The patient was discharged home with no ongoing symptoms.There is no consensus regarding the optimal management of such cases. On reviewing the literature, we felt an epidural blood patch was preferable for our symptomatic patient, noting a case where this was used effectively to manage a persistent CSF leak following spinal catheter insertion during transphenoidal pituitary surgery [2]. Neurosurgical review has also highlighted that epidural blood patch can be beneficial in managing CSF leak following spinal surgery, particularly when the location of the leak is unknown [3].This complication may be more common than previously thought. Such cases provoke thought regarding the use of intrathecal catheters in the management of accidental dural puncture as the development of a CSF leak may be more concerning than a post-dural puncture headache.
Summary Which journals cite work published in anaesthetic journals is of potential interest to authors, editors and publishers. We analysed citations made in 2017–2018 for articles, reviews, editorials and letters published by 12 anaesthetic journals in 2016, using the Web of Science™ citation index platform. We analysed 12,544 citations made for 3518 items. Citations were most often made by specialist anaesthesia journals and critical care journals, and occurred most commonly in articles, followed by reviews, editorials and letters. The median (IQR [range]) number of citations made per item was 3.3 (2.6–4.1 [1.6–5.1]). The median (IQR [range]) number of journals that cited the 12 source journals was 302 (236–449 [139–671]). The median (IQR [range]) proportion of citations made by the same journal that published the items (i.e. ‘self‐citations’) was 15% (11–17% [5–32%]). There were 1305/1932 (68%) citations made by North American journals for items published in North American journals and 1712/2063 (83%) citations made by European journals for items published in European journals, p < 0.0001. Our analysis may inform authors, editors and publishers where to submit work, what editorial policy to pursue and what journal strategy to follow, respectively.
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