Recomendações da SBA para segurança na anestesia regional em uso de anticoagulantes

Fonseca, Neuber Martins; Alves, Ronaldo; Pontes, João Paulo Jordão

doi:10.1016/j.bjan.2013.04.008

Cited by 5 publications

(2 citation statements)

References 97 publications

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“…40,41,56,57 Societal recommendations for anesthetic neuraxial procedures most commonly used a limit of 80,000 × 10 6 /L. 58 However, the Scandinavian Society of Anaesthesiology recommends lower thresholds for anesthetic neuraxial procedures that are thought to be associated with a lower risk for anesthesia-related morbidity and mortality than the alternative, general anesthesia. Likewise, they recommend a lower threshold for single-shot spinal compared to epidural procedures.…”

Section: Recommendations From Other Professional Organizations Regard...mentioning

confidence: 99%

The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia

Bauer

Arendt

Beilin

et al. 2021

Anesthesia &Amp; Analgesia

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Because up to 12% of obstetric patients meet criteria for the diagnosis of thrombocytopenia in pregnancy, it is not infrequent that the anesthesiologist must decide whether to proceed with a neuraxial procedure in an affected patient. Given the potential morbidity associated with general anesthesia for cesarean delivery, thoughtful consideration of which patients with thrombocytopenia are likely to have an increased risk of spinal epidural hematoma with neuraxial procedures, and when these risks outweigh the relative benefits is important to consider and to inform shared decision making with patients. Because there are substantial risks associated with withholding a neuraxial analgesic/anesthetic procedure in obstetric patients, every effort should be made to perform a bleeding history assessment and determine the thrombocytopenia etiology before admission for delivery. Whereas multiple other professional societies (obstetric, interventional pain, and hematologic) have published guidelines addressing platelet thresholds for safe neuraxial procedures, the US anesthesia professional societies have been silent on this topic. Despite a paucity of high-quality data, there are now meta-analyses that provide better estimations of risks. An interdisciplinary taskforce was convened to unite the relevant professional societies, synthesize the data, and provide a practical decision algorithm to help inform risk-benefit discussions and shared decision making with patients. Through a systematic review and modified Delphi process, the taskforce concluded that the best available evidence indicates the risk of spinal epidural hematoma associated with a platelet count ≥70,000 × 106/L is likely to be very low in obstetric patients with thrombocytopenia secondary to gestational thrombocytopenia, immune thrombocytopenia (ITP), and hypertensive disorders of pregnancy in the absence of other risk factors. Ultimately, the decision of whether to proceed with a neuraxial procedure in an obstetric patient with thrombocytopenia occurs within a clinical context. Potentially relevant factors include, but are not limited to, patient comorbidities, obstetric risk factors, airway examination, available airway equipment, risk of general anesthesia, and patient preference.

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Section: Recommendations From Other Professional Organizations Regard...mentioning

confidence: 99%

The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia

Bauer

Arendt

Beilin

et al. 2021

Anesthesia &Amp; Analgesia

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“…Foram excluídos do estudo os pacientes que se recusaram a participar ou que apresentaram contraindicação à anestesia regional (Infecção ou deformidade anatômica grave em sítio de punção), distúrbio da coagulação (INR > 1,4 ou uso de medicações anticoagulantes e contagem de plaquetas menor que 100.000/mm 3 ) (74) , Índice de massa corpórea ≥ 35, estágio avançado de disfunção renal (Clearance de creatinina < 30 ml/min) devido ao risco de intoxicação por morfina, incapacidade de operar o sistema de PCA ou de assinatura do termo de consentimento livre e esclarecido, e aqueles submetidos a cirurgias torácicas bilaterais. (75) 4.…”

Section: População Do Estudounclassified

Comparação de analgesia do bloqueio do plano eretor da espinha em cirurgias pulmonares em relação ao bloqueio paravertebral: estudo multicêntrico randomizado

Filho¹

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Aos meus pais, Pedro e Edilma, meus gigantes que me colocaram nos ombros e me permitiram enxergar mais longe. À Carolina, pela fé inabalável e amor diário, que fazem tudo valer a pena.A Vitor e Vinícius, irmãos de sangue, e Rômulo e Talison, irmãos de vida, pelo exemplo e apoio constantes na busca pela excelência. AGRADECIMENTOSAo Prof. Dr. João Manoel, amigo singular, orientador e conselheiro de todos os momentos. Obrigado por todos os ensinamentos, generosidade e exemplo de dedicação ao trabalho.

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Should a Peripheral Nerve Block Be Placed in an Anticoagulated Patient?

Song

Chuy

2016

You’re Wrong, I’m Right

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Recomendações da SBA para segurança na anestesia regional em uso de anticoagulantes

Cited by 5 publications

References 97 publications

The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia

The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia

Comparação de analgesia do bloqueio do plano eretor da espinha em cirurgias pulmonares em relação ao bloqueio paravertebral: estudo multicêntrico randomizado

Should a Peripheral Nerve Block Be Placed in an Anticoagulated Patient?

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