Epidural Anesthesia and Analgesia in High-risk Surgical Patients

Yeager, Mark P.; Glass, D. David; Neff, Raymond K.; Brinck‐Johnsen, Truls

doi:10.1097/00000542-198706000-00004

Cited by 931 publications

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“…The lack of suppression of neuroendocrine responses, indicated by the increase in serum cortisol in both groups, is consistent with other studies of various abdominal and other major procedures. 10,[14][15][16]17 Diminished serum cortisol responses in patient groups receiving epidural anaesthesia compared with controls have been reported in some instances ~4-16 but not in others. 1s.…”

Section: Discussionmentioning

confidence: 99%

Epidural anaesthesia and analgesia do not affect energy expenditure after major abdominal surgery

et al. 1993

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Section: Discussionmentioning

confidence: 99%

Epidural anaesthesia and analgesia do not affect energy expenditure after major abdominal surgery

et al. 1993

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“…Uma analgesia adequada auxilia na recuperação do paciente, proporcionando melhor evolução clínica e alta hospitalar precoce (1)(2)(3)(4)(5) .…”

Section: Introductionunclassified

“…Em cirurgias de grande porte e de longa duração, a anestesia peridural é geralmente, associada à anestesia geral e o cateter peridural pode ser mantido no pós-operatório para infusão de solução analgésica ao paciente (4)(5) . O cateter peridural utilizado no pós-operatório é de curta permanência, ficando em média, quatro dias ou enquanto houver dor que justifique a utilização de analgésicos por essa via.…”

Section: Introductionunclassified

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Colonização e infecção em pacientes com cateter peridural não tunelizado para analgesia

et al. 2010

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Colonização e infecção em pacientes com cateter peridural não tunelizado para analgesia* RESUMO Objetivo: Correlacionar a colonização e a infecção no paciente em uso do cateter peridural não tunelizado para analgesia. Métodos: Estudo prospectivo realizado com 109 pacientes clínicos ou cirúrgicos e com tempo de permanência do cateter >72 horas em um hospital privado do Município de São Paulo. A cultura de vigilância foi realizada com base na coleta da ponta do cateter peridural, swab pericateter e hemocultura periférica. Resultados: Dentre os 109 acompanhados 109 pacientes, 106 (97,2%) foram cirúrgicos e 3 (2,8%) clínicos. O tempo de permanência do cateter variou de 3 a 18 dias e a taxa de colonização foi de 11%. Doze pacientes apresentaram colonização do cateter peridural e o principal micro-organismo isolado foi o Staphylococcus coagulase-negativa. Conclusões: A cultura positiva do cateter peridural constituiu um fator preditor para a colonização, porém nenhum paciente com positividade evoluiu com infecção. Descritores: Analgesia epidural; Cuidados de enfermagem; Dor; Infecção/prevenção & controle ABSTRACTObjective: To correlate the colonization and infection in patients using non-tunneled epidural catheter for analgesia effects. Methods: This is a prospective study of 109 clinical or surgical patients, with catheter dwell time> 72 hours, in a private hospital in the city of Sao Paulo. The culture of surveillance was carried out based on the collection of the epidural catheter tip, swab peri-catheter and peripheral blood cultures. Results: Among the 109 patients accompanied, 106 (97.2%) were surgical and 3 (2.8%) clinical. The catheter dwell time ranged from 3 to 18 days and the rate of colonization was 11%. Twelve patients had epidural catheter colonization and the main organism isolated was coagulase-negative Staphylococcus. Conclusions: The positive culture of epidural catheter was a predictive factor for colonization; however, it was not found positive patients who evolved to infection. Keywords: Epidural analgesia; Nursing care; Pain; Infection/prevention & control RESUMENObjetivo: Correlacionar la colonización y la infección, en pacientes que usan catéter peridural no tunelizado para efectos de analgesia. Métodos: Se trata de un estudio prospectivo realizado con 109 pacientes clínicos o quirúrgicos, con tiempo de permanencia del catéter >72 horas, en un hospital privado del Municipio de Sao Paulo. La cultura de vigilancia fue realizada con base en la recolección de la punta del catéter peridural, swab pericatéter y hemocultura periférica. Resultados: Entre los 109 pacientes acompañados, 106 (97,2%) fueron quirúrgicos y 3 (2,8%) clínicos. El tiempo de permanencia del catéter varió de 3 a 18 días y la tasa de colonización fue de 11%. Doce pacientes presentaron colonización del catéter peridural y el principal microorganismo aislado fue el Staphylococcus coagulase-negativa. Conclusiones: La cultura positiva del catéter peridural constituyó un factor de predicción para la colonización, sin embargo no se encon...

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“…1,2 Until recently, however, it did not appear reasonable to consider advanced age a contraindication for epidural anesthesia in light of the evidence for the potential benefits of this technique compared to general anesthesia alone. [14][15][16] In the last three years, on the other hand, the magnitude of such benefits has come into question, [17][18][19] which may lead clinicians to re-evaluate the risk-benefit analysis of epidural anesthesia in the elderly.Finally, this case provides the first document to our knowledge of neurologic recovery from spinal epidural hematoma following epidural anesthesia without decompressive laminectomy in a nonagenarian. Persson et al reported recently on a 74-yr-old patient who had received a thoracic epidural catheter and recovered neurologically despite surgery being delayed for three days after diagnosis.…”

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La récupération spontanée après un hématome épidural rachidien de présentation atypique chez une nonagénaire

Schwarz

Wong

McDonald

2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Spinal epidural hematoma following epidural anesthesia is extraordinarily rare in association with low-dose sc heparin, and the prognosis for neurologic recovery without rapid surgical decompression poor. We report a case of spinal epidural hematoma in a nonagenarian who received low-dose sc unfractionated heparin postoperatively in accordance with standard guidelines, presented with no back pain, and made full neurologic recovery without surgical intervention.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 90-yr-old female with gastric adenocarcinoma presented for subtotal gastrectomy. Her past medical history and physical examination were largely unremarkable and she had no bleeding diathesis. She took no medications other than preoperative ranitidine, and had a normal coagulation profile. A thoracic epidural catheter was placed uneventfully before induction of general anesthesia. Postoperatively, low-dose sc unfractionated heparin was started 12 hr after the epidural catheter insertion. On postoperative day two, the patient developed flaccid lower extremity paralysis and paresthesia without back pain. Her coagulation profile remained normal. Subsequent magnetic resonance imaging showed a large epidural hematoma extending from T3 to T11. With conservative treatment and no surgery, the patient slowly made full neurologic recovery and was discharged home on postoperative day 56.C Co on nc cl lu us si io on n: : Complete neurologic recovery from flaccid paralysis following spinal epidural hematoma occurred without surgical decompression in a nonagenarian. Low-dose sc heparin may be a greater risk factor for spinal epidural hematoma than previously assumed, and the absence of back pain does not rule out this diagnosis. PINAL epidural hematoma is a rare complication of epidural anesthesia with an estimated incidence of 1:190,000 and potentially devastating consequences. 1 Identified risk factors include difficult or traumatic needle/catheter insertion, ankylosing spondylitis, and anticoagulation/coagulopathy 1,2 whereas treatment with low-dose unfractionated heparin is generally considered safe. 3 Typical presentation is with sharp back pain and associated motor and sensory deficit progressing to paraplegia, with a poor prognosis of recovery if decompressive laminectomy is not performed within eight hours. Here, we report a case of spinal epidural hematoma in a 90-yr-old patient with no history of coagulopathy, multiple/traumatic needle insertion or catheter manipulation who received low-dose sc unfractionated heparin postoperatively in accordance with current standard guidelines, presented with no back pain, and made full neurologic recovery without surgical intervention. ObjectifC Ca as se e r re ep po or rt t A 90-yr-old Caucasian female [weight, 57 kg; American Society of Anesthesiologists (ASA) physical status class II] presented with gastric adenocarcinoma and was taken to the operating room for subtotal gastrectomy with creation of a Roux-en-Y anastomosis and feeding jejunosto...

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Epidural Anesthesia and Analgesia in High-risk Surgical Patients

Cited by 931 publications

References 0 publications

Epidural anaesthesia and analgesia do not affect energy expenditure after major abdominal surgery

Epidural anaesthesia and analgesia do not affect energy expenditure after major abdominal surgery

Colonização e infecção em pacientes com cateter peridural não tunelizado para analgesia

La récupération spontanée après un hématome épidural rachidien de présentation atypique chez une nonagénaire

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