Continuous epidural anesthesia in abdominal vascular surgery

Cunningham, Francis O.; Egan, John M.; Inahara, Toshio

doi:10.1016/0002-9610(80)90349-9

Cited by 33 publications

(5 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The authors thought that the advantages obtained with the regional anaesthetic technique in these high risk patients outweighed the risk of epidural haematoma formation. Similar conclusions were drawn by Cunningham et al (59). Sage (60) summarized studies published from 1979 to 1988 on heparinisation following epidural/spinal insertion in more than 7000 patients and found no reported incidence of spinal haematoma.…”

Section: Risk and Diagnosis Of Spinal Bleeding Complicationssupporting

confidence: 74%

Thromboprophylaxis, coagulation disorders, and regional anaesthesia

Haljamäe

1996

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

The surgery and trauma‐induced modulation of the coagulation system includes a considerable risk of perioperative thromboembolic complications unless effective thromboprophylactic treatment is given. In the present survey the patient at risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) is characterized and the documented efficacy of different currently used thromboprophylactic regimens is summarized. Systemic thromboprophylactic treatment may include a risk of an increased bleeding tendency which may lead to haemorrhagic complications. In patients with a coagulation abnormality or in patients receiving anticoagulants for perioperative thromboprophylaxis there is a fear among anaesthesiologists that the use of regional anaesthesia (spinal or epidural) may be associated with spinal haemorrhagic complications, i.e. with spinal haematoma formation leading to compression of the spinal cord and severe neurologic sequelae. Present aspects on the risk of spinal haematoma formation at the combined use of pharmacological thromboprophylactic regimens and spinal or epidural anaesthesia/analgesia are therefore summarized. Pregnancy is associated with changes in the haemostatic system, which in the preeclamptic or eclamptic patient may be rather pronounced and constitute a clinical problem since regional anaesthetic techniques are often preferred for obstetric anaesthesia/analgesia. The specific problems to be considered prior to the choice of regional anaesthesia/analgesia for a parturient with a suspected coagulation disorder are therefore commented on in more detail. Finally, recommendations are given for safe spinal and epidural analgesic and anaesthetic routines in patients with potential haemostatic disturbances due to thromboprophylactic treatment with anticoagulants or bleeding disorders.

show abstract

Section: Risk and Diagnosis Of Spinal Bleeding Complicationssupporting

confidence: 74%

Thromboprophylaxis, coagulation disorders, and regional anaesthesia

Haljamäe

1996

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

show abstract

“…Cunningham and colleagues initially evaluated the utility of epidural anesthesia nearly two decades ago when they reported its usage in 100 consecutive patients [17]. These researchers demonstrated a reduction in general anesthetic and narcotic requirements as well as a decline in postoperative pain on a subjective scale.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, their results noted a significant reduction of postoperative pulmonary complications in panents treated with epidural anesthesia and local anesthet-ICS. A possible mechanism for the reduced pulmonary morbidity was that epidural narcotics and local anesthetics provided both analgesia and musc~e relaxation, which avoided large doses of systemic narcotics and thus permitted adequate respirarorv performance by the diaphragm and accessory respiratory muscle [17].…”

Section: Discussionmentioning

confidence: 99%

Epidural Analgesia in Patients with Chronic Obstructive Pulmonary Disease Undergoing Transperitoneal Abdominal Aortic Aneurysmorraphy — A Multi-Institutional Analysis

Bush

Lin

Reddy

et al. 2003

Cardiovascular Surgery

View full text Add to dashboard Cite

Introduction: Patients with chronic obstructive pulmonary disease (COPD) are more likely to develop pulmonary morbidity following major abdominal surgery. The purpose of this study was to examine the utility of epidural analgesia in patients with COPD who underwent elective transperitoneal abdominal aortic aneurysm (AAA) repair. Methods: During a 7-year period, all patients diagnosed with COPD undergoing elective AAA repair ( n=425) from three hospitals were reviewed. Inclusion criteria were an FEV1/FVC ratio <75% and/or a PaCO2>45 mmHg. Clinical outcomes were compared between those who received epidural analgesia (epidural group) and those who did not (control group). Primary endpoints measured were duration of intubation, ICU stay, hospital days. and pulmonary complications. Results: Strict inclusion criteria were met by 131 patients, which included 86 patients in the epidural group and 45 patients in the control group. When comparing the epidural vs. control group, the mean AAA size was 6.3±0.9 cm vs. 6.0±1.5 cm (NS), FEV1 was 57.2±24.7% vs. 49.0±10.3% (NS), and the mean FFV1/FVC ratio was 52.0±11.4% vs. 50.6±6.7% (NS), respectively. The epidural group had a significantly lower incidence of post-operative ventilator dependency and ICU stay ( p<0.05), as well as a decreased trend in pulmonary complications when compared to the control group. The overall hospital stay remained similar between the two groups. The relative risk of developing a pulmonary complication in the absence of epidural analgesia was 2.3 Conclusions: Perioperative epidural analgesia is beneficial in patients with COPD undergoing AAA repair by reducing both the post-operative ventilator duration and ICU stay. Epidural analgesia should be considered in all COPD patients undergoing elective transperitoneal AAA repair.

show abstract

“…Epidural anesthesia alone was successfully used for Accepted for publication Dec 20,1988 (2) FVC, less than 50% of predicted; (3) FEV/FVC, less than 50% of predicted; (4) FEV, less than 1.0 L; (5) FVC less than 1.5 L; (6) FEV./FVC less than 35% of predicted; and (7) maximal ventilatory volume less than 50% of predicted.…”

mentioning

confidence: 99%