Epidural Hematoma After Epidural Anesthesia in a Patient with Hepatic Cirrhosis

Morisaki, Hiroshi; Doi, Jun; Ochiai, Ryoichi; Takeda, Junzo; Fukushima, Kazuaki

doi:10.1213/00000539-199505000-00031

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…In patients with portal hypertension, blood may be diverted to the epidural veins, which are devoid of valves, and therefore become dilated and prone to bleeding 120 . There are, five case reports where liver disease was implicated 121–125 . One SH occurred after a lumbar puncture, 124 and one in a patient who had thrombocytopenia and a recent fracture of the vertebra at the level where an EDA catheter was inserted 125 .…”

Section: Resultsmentioning

confidence: 99%

Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Breivik

Bang

Jalonen

et al. 2009

Acta Anaesthesiol Scand

155

161

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Section: Resultsmentioning

confidence: 99%

Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Breivik

Bang

Jalonen

et al. 2009

Acta Anaesthesiol Scand

155

161

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“…All had potential risk factors in addition to thrombocytopenia. Rapidly falling platelet counts and prolongation of the prothrombin time were reported by three (Gustafsson et al , 1988; Morisaki et al , 1995; Ozgen et al , 2004), two of which also had liver disease (Gustafsson et al , 1988; Morisaki et al , 1995). A further paper described a patient with liver cirrhosis and platelet count <100 × 10 9 /l without further information (Tamakawa & Ogawa, 1998) and the last study described a patient with acute myeloid leukaemia, prior allogeneic bone marrow transplant and aspergillus pneumonia who was found to have an epidural haematoma on autopsy after having had an epidural catheter placed for pain relief and a platelet count between 10 and 48 × 10 9 /l (Wulf et al , 1988).…”

Section: Case Reports In Regional Anaesthesiamentioning

confidence: 98%

“…Limited to case reports reporting on either epidural or single episodes of spinal anaesthesia without any form of anticoagulation, we identified 21 such reports (12 epidurals, nine spinal anaesthesia) at platelet counts <100 × 10 9 /l at the time of puncture or catheter removal (Bailey et al , 1999; Moen et al , 2004; Nguyen et al , 2006; Morisaki et al , 1995; Gustafsson et al , 1988; Chang et al , 2003; Ezri et al , 2002; Harnett et al , 2000; Hew‐Wing et al , 1989; Kuczkowski & Benumof, 2002; Landau et al , 2003; Moeller‐Bertram et al , 2004; Nafiu et al , 2004; Ozgen et al , 2004; Raft et al , 2005; Sibai et al , 1986; Steer, 1993; Tamakawa & Ogawa, 1998; Wulf et al , 1988; Yuen et al , 1999). Sixteen were for analgesia during delivery (Bailey et al , 1999; Nguyen et al , 2006; Moen et al , 2004; Chang et al , 2003; Ezri et al , 2002; Harnett et al , 2000; Hew‐Wing et al , 1989; Kuczkowski & Benumof, 2002; Landau et al , 2003; Moeller‐Bertram et al , 2004; Nafiu et al , 2004; Raft et al , 2005; Steer, 1993; Yuen et al , 1999; Sibai et al , 1986).…”

Section: Case Reports In Regional Anaesthesiamentioning

confidence: 99%

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The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

2009

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Summary Neuraxial anaesthesia is increasingly performed in thrombocytopenic patients at the time of delivery of pregnancy. There is a lack of data regarding the optimum platelet count at which spinal procedures can be safely performed. Reports are often confounded by the presence of other risk factors for spinal haematomata, such as anticoagulants, antiplatelet agents and other acquired or congenital coagulopathies/platelet function defects or rapidly falling platelet counts. In the absence of these additional risk factors, a platelet count of 80 × 109/l is a ‘safe’ count for placing an epidural or spinal anaesthetic and 40 × 109/l is a ‘safe’ count for lumbar puncture. It is likely that lower platelet counts may also be safe but there is insufficient published evidence to make recommendations for lower levels at this stage. For patients with platelet counts of 50–80 × 109/l requiring epidural or spinal anaesthesia and patients with a platelet count 20–40 × 109/l requiring a lumbar puncture, an individual decision based on assessment of risks and benefits should be made.

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“…In 15 of the 32 patients, the haematoma followed removal of the epidural catheter. Other case reports over the last decade continue to document spinal/epidural haematoma after epidural catheter removal, both among patients who had received anticoagulants [9][10][11] , and in those who had not 12,13 .…”

Section: Discussionmentioning

confidence: 99%

Delayed Epidural Catheter Removal: The Impact of Postoperative Coagulopathy

Tsui

Yong

et al. 2004

Anaesth Intensive Care

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A retrospective analysis of 413 patients who received postoperative epidural analgesia under a standardized protocol found that 84 (20%) had a duration of epidural catheterization of greater than four days. The most common reasons were significant pain (n=64, 15%) and coagulopathy (n=26, 6%). Risk factor analysis for coagulopathy showed an odds ratio of 10.1 (95% confidence interval 4.2-24.5) for prolonged epidural catheterization among patients undergoing hepatectomy. Magnetic resonance imaging, performed in four patients with clinical signs suggestive of epidural haematoma, was negative for a space-occupying lesion in all cases. Eleven patients developed fever and clinical signs suggestive of epidural catheter-related infection, necessitating early catheter removal. Sixteen patients had persistent lower limb weakness at 24 hours after catheter removal. The signs soon resolved in all except two, one of whom had neuropathy related to intraoperative positioning and the other preoperative weakness. Accidental epidural catheter dislodgement occurred in 29 patients (7%) and is potentially hazardous if coagulopathy is unresolved. The riskbenefit ratio and factors complicating catheter removal, especially coagulopathy, should be considered when deciding whether to use epidural techniques.

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Epidural Hematoma After Epidural Anesthesia in a Patient with Hepatic Cirrhosis

Cited by 6 publications

References 9 publications

Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

Delayed Epidural Catheter Removal: The Impact of Postoperative Coagulopathy

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