Epidural anaesthesia and spinal haematoma

Wulf, Hinnerk

doi:10.1007/bf03013437

Cited by 319 publications

(188 citation statements)

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“…Although the risk of traumatic neuraxial hemorrhage remains a major issue for the obstetrical anesthesiologist, 8,9 there are few established risk factors for this serious but rare event. 8,9,35 The development of a spinal hematoma is not guaranteed in the face of a prolonged BT and would likely remain a rare event even in the presence of a bleeding diathesis.…”

Section: Discussionmentioning

confidence: 99%

“…8,9,35 The development of a spinal hematoma is not guaranteed in the face of a prolonged BT and would likely remain a rare event even in the presence of a bleeding diathesis. Increasing experience and the use of more modern techniques for neuraxial blockade, including the selective use of a single spinal block instead of insertion of an epidural catheter, could translate into a lower baseline risk for traumatic hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] These patients often require rapid Cesarean delivery, leaving the anesthesiologist with the dilemma of providing optimal analgesia while minimizing bleeding risk. 6,7 This decision may be further complicated by the unpredictability of hemorrhagic misadventure, such as epidural hematoma with the use of neuraxial anesthesia, 8,9 and the perceived potential for litigation. 1 0 Although many obstetrical anesthesiologists now use the platelet count, international normalized ratio (INR) and activated partial thromboplastin time (aPTT) as indicators of hemorrhagic risk, 11,12 others continue to rely on the bleeding time (BT) in certain situations.…”

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confidence: 99%

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Platelet count may predict abnormal bleeding time among pregnant women with hypertension and preeclampsia

McDonagh

Ray

Burrows

et al. 2001

Can J Anesth/J Can Anesth

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Background: Anesthesiologists often require laboratory data to estimate the bleeding risk among hypertensive pregnant women prior to administering regional anesthesia. Many rely on the bleeding time (BT) in making this determination. We examined whether the platelet count can adequately predict BT among a group of hypertensive parturients.Methods: This retrospective subgroup analysis, taken from a cohort of 2051 hypertensive pregnant women, comprises 87 individuals who underwent both a BT and platelet count prior to delivery. We calculated the correlation between the platelet count and BT at three platelet cut-off points with respect to prolonged BT of eight minutes or more.Results: There was a significant negative correlation between platelet count at delivery and BT [r= -0.45, 95% confidence interval (CI) -0.26 to -0.60; P <0.0001]. All three platelet cut-off points had a sensitivity of less than 66% with negative predictive values below 75% for an abnormal BT. A platelet count #75 x 10 9 /L was specific for the presence of an abnormal BT (specificity 97.8%, 95% CI 91.7-100.0), with a positive predictive value of 95.5% (95% CI 83.1-100.0) and a positive likelihood ratio of 24 (95% CI 3.3-168).Conclusions: In a group of hypertensive parturients, the platelet count appears to be very specific for predicting a prolonged BT. The

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Platelet count may predict abnormal bleeding time among pregnant women with hypertension and preeclampsia

McDonagh

Ray

Burrows

et al. 2001

Can J Anesth/J Can Anesth

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“…5 Epidural catheter placement may also be associated with a higher rate of complications, including spinal hematomas. 7 Based on this literature, we chose to use a soft epidural catheter initially, as it may reduce the risk of epidural vein puncture. 8 An interesting fact of this case report was the lack of rostral spread of local anesthesia, even though two successful epidural catheters were placed with ease at the L3-L4 interspace.…”

Section: Discussionmentioning

confidence: 99%

Failed epidural analgesia in a parturient with advanced ankylosing spondylitis: a novel explanation

Hoffman

Zaphiratos

Girard

et al. 2012

Can J Anesth/J Can Anesth

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Purpose Ankylosing spondylitis (AS) is a chronic progressive multisystemic disease. Patients with AS present a specific set of anesthesia-related challenges, and the parturient with AS presents particular anesthetic considerations. We report our experience with a parturient with advanced AS and offer a novel explanation for the high incidence of epidural failures in this patient population. Clinical features We present the case of a 36-yr-old primigravida parturient with a very difficult airway and a history of severe AS. The initial treatment plan was to use a continuous epidural for labour analgesia. Despite two successful placements of lumbar epidural catheters, adequate rostral spread of local anesthesia to control her labour pain was never achieved via the epidural route. Thus, continuous spinal anesthesia was used, which provided effective labour analgesia in this patient. Conclusion We hypothesize that this patient's advanced calcified posterior longitudinal ligament caused a physical barrier to rostral spread of local anesthesia solution within her epidural space. This hypothesis is supported by a recent study highlighting the importance of this ligament in allowing adequate distribution of solution within the epidural space. In addition, the successful use of continuous spinal analgesia adds to the growing body of literature supporting the safety and efficacy of intrathecal catheters for labour analgesia in specific situations. RésuméObjectif La spondylarthrite ankylosante (SpA) est une maladie chronique e´volutive affectant plusieurs syste`mes. Les patients souffrant de SpA posent une se´rie de de´fis spe´cifiques lie´s à l'anesthe´sie et les proble`mes d'une parturiente souffrant de SpA ne´cessitent une approche encore plus e´labore´e. Nous de´crivons notre expe´rience avec une parturiente atteinte de SpA avance´e et proposons une nouvelle explication pour l'incidence e´leve´e d'e´checs de la pe´ridurale dans cette population de patientes. Caractéristiques cliniques Nous pre´sentons le cas d'une parturiente de 36 ans, primipare, ayant des ante´ce´dents de SpA se´ve`re et des voies ae´riennes difficiles. Le plan the´rapeutique initial consistait a`utiliser une pe´ridurale continue pour l'analge´sie au cours du travail. Malgre´la mise en place re´ussie de deux cathe´ters pe´riduraux par voie lombaire, une diffusion rostrale approprie´e de l'anesthe´sie locale pour atte´nuer sa douleur n'a jamais e´teó btenue par voie pe´ridurale. En conse´quence, une

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“…Vascular malformations, a deformed verterbral column, and other anatomical abnormalities may enhance the risk for spinal bleeding (9,11). Other risk factors include the anesthetic technique with a temporary epidural catheter for postoperative pain relief, or catheter removal, which may increase the risk of hematoma formation.…”

Section: Discussionmentioning

confidence: 99%

Thoracic epidural anesthesia and epidural hematoma

Persson

Flisberg

Lundberg

2002

Acta Anaesthesiol Scand

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This report involves a 74‐year‐old‐male who developed a thoracic epidural hematoma with paraparesis on the second postoperative day in conjunction with thoracic epidural anesthesia established before surgery for acute abdominal aortic dissection.The finding indicates that laminectomy can be performed successfully as late as three days after diagnosis of the hematoma, with a complete restitution of neurological function. High‐dose steroid treatment may have been a contributing factor for the positive outcome.

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Epidural anaesthesia and spinal haematoma

Abstract: Purpose: Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. This paper presents a comprehensive review of case reports. Source: Sampling of case reports over a 10 yr period, medline | -research (1966-1995)

Cited by 319 publications

References 76 publications

Platelet count may predict abnormal bleeding time among pregnant women with hypertension and preeclampsia

Platelet count may predict abnormal bleeding time among pregnant women with hypertension and preeclampsia

Failed epidural analgesia in a parturient with advanced ankylosing spondylitis: a novel explanation

Thoracic epidural anesthesia and epidural hematoma

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