A Widened Mediastinum in a Patient With a Left Parasternal Stab Wound

Iqbal, Zafar; Gandhi, Sweeta D.; Markan, Sandeep; Nicolosi, Alfred C.; Pagel, Paul S.

doi:10.1053/j.jvca.2006.06.002

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…and catheter removal under LMWH, warfarin, and aspirin thromboprophylaxis were considered safe 192 . The risk of minor bleeding was calculated as 0.7% (95% CI 0.2 to 4.1) in a study wherein no haematoma was associated with paravertebral thoracic blocks, even though more than 90% of catheter procedures were performed in the presence of a bleeding risk 193 . When examining continuous or single shot PNB in hip or knee arthroplasty patients receiving prophylactic rivaroxaban, there was no increased risk of major bleeding after one or two doses of rivaroxaban administered postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…192 The risk of minor bleeding was calculated as 0.7% (95% CI 0.2 to 4.1) in a study wherein no haematoma was associated with paravertebral thoracic blocks, even though more than 90% of catheter procedures were performed in the presence of a bleeding risk. 193 When examining continuous or single shot PNB in hip or knee arthroplasty patients receiving prophylactic rivaroxaban, there was no increased risk of major bleeding after one or two doses of rivaroxaban administered postoperatively. Although 80% of minor haemorrhages occurred at the puncture site prior to the administration of thromboprophylaxis in superficial continuous blocks (femoral), no major haemorrhages were observed in deep continuous blocks (lumbar and sciatic).…”

Section: Recommendation 38mentioning

confidence: 98%

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Regional anaesthesia in patients on antithrombotic drugs

Kietaibl

Ferrandis

Godiér

et al. 2022

European Journal of Anaesthesiology

102

103

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BACKGROUND Bleeding is a potential complication after neuraxial and peripheral nerve blocks. The risk is increased in patients on antiplatelet and anticoagulant drugs. This joint guideline from the European Society of Anaesthesiology and Intensive Care and the European Society of Regional Anaesthesia aims to provide an evidence-based set of recommendations and suggestions on how to reduce the risk of antithrombotic drug-induced haematoma formation related to the practice of regional anaesthesia and analgesia. DESIGN A systematic literature search was performed, examining seven drug comparators and 10 types of clinical intervention with the outcome being peripheral and neuraxial haematoma. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the methodological quality of the included studies and for formulating recommendations. A Delphi process was used to prepare a clinical practice guideline. RESULTS Clinical studies were limited in number and quality and the certainty of evidence was assessed to be GRADE C throughout. Forty clinical practice statements were formulated. Using the Delphi-process, strong consensus (>90% agreement) was achieved in 57.5% of recommendations and consensus (75 to 90% agreement) in 42.5%. DISCUSSION Specific time intervals should be observed concerning the adminstration of antithrombotic drugs both prior to, and after, neuraxial procedures or those peripheral nerve blocks with higher bleeding risk (deep, noncompressible). These time intervals vary according to the type and dose of anticoagulant drugs, renal function and whether a traumatic puncture has occured. Drug measurements may be used to guide certain time intervals, whilst specific reversal for vitamin K antagonists and dabigatran may also influence these. Ultrasound guidance, drug combinations and bleeding risk scores do not modify the time intervals. In peripheral nerve blocks with low bleeding risk (superficial, compressible), these time intervals do not apply. CONCLUSION In patients taking antiplatelet or anticoagulant medications, practitioners must consider the bleeding risk both before and after nerve blockade and during insertion or removal of a catheter. Healthcare teams managing such patients must be aware of the risk and be competent in detecting and managing any possible haematomas.

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Section: Discussionmentioning

confidence: 99%

Section: Recommendation 38mentioning

confidence: 98%

Regional anaesthesia in patients on antithrombotic drugs

Kietaibl

Ferrandis

Godiér

et al. 2022

European Journal of Anaesthesiology

102

103

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“…Four patients were in shock status before the operation, and the other patient was sent back to the operating room due to massive hemothorax after receiving laparotomy for intra-abdominal bleeding. Fourteen patients underwent surgery after the initial CT scan, including 4 patients for shock (1,12,28), three for extracardiac tamponade (10,16,23), two for massive hemothorax(1), two for both extracardiac tamponade and hemothorax (1,24), one for a large aneurysm (25), one for a foreign body (5), and one for persistent bleeding after pericardiotomy (11). Seven patients underwent surgery after angiography.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Internal Mammary Injury— A Literature Review and Guide for Management

Wu¹,

Liao²,

Liao³

et al. 2020

Preprint

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BackgroundTraumatic internal mammary artery (IMA) injury is a rare but clinically significant injury since it is linked to various troublesome conditions. In this review, we aim to provide a complete description and a practical strategy for managing this injury.MethodsPubMed, Embase, and the Web of Science were searched from 1960 to 2019. We also reviewed IMA injuries in our hospital. Only traumatic IMA injuries were included. The demographics, diagnostic procedures, treatments and outcomes were recorded and analyzed.ResultsThere were a total of 72 IMA injury cases, including 4 in our hospital. The injuries were predominantly in males (79.2%), were on the left side (66.7%), were considered blunt injuries (63.9%), and featured mediastinal hematoma (62.5%). Computed tomography (CT) has been used to diagnose IMA injuries in recent years. Most patients could be managed by nonsurgical treatments (61.2%). The outcome for IMA injury is very good, with low morbidity and mortality rates.ConclusionsIdentifying traumatic IMA injuries requires alertness from the physicians. An appropriate management chosen according to the patient’s individualized condition could lead to a satisfying result.Trial registration: not applicable

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