Intraspinal haematoma following lumbar epidural anaesthesia in a neonate

Breschan, Christian; Krumpholz, R.; Jost, Robert; Likar, Rudolf

doi:10.1046/j.1460-9592.2001.00593.x

Cited by 36 publications

(13 citation statements)

References 18 publications

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“…However, coagulopathy and bleeding disorders are relatively rare in children, and drugs affecting coagulation function are less frequently used in pediatric patients than in adults and elderly patients (26). Although very rare cases of neuraxial hematomas have been reported in children with diagnostic lumbar puncture (27) and epidural anesthesia (28), spinal anesthesia should be safe if there is no positive family or patient history for major dysfunction in coagulation system (29). However, an alternative anesthetic technique should be considered when there are difficulties to identify the subarachnoidal space.…”

Section: Contraindications To Spinal Anesthesiamentioning

confidence: 99%

Spinal blocks

Kokki

2011

Pediatric Anesthesia

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Every anesthetist should have the expertise to perform lumbar puncture that is the prerequisite to induce spinal anesthesia. Spinal anesthesia is easy and effective technique: small amount of local anesthetic injected in the lumbar cerebrospinal fluid provides highly effective anesthesia, analgesia, and sympathetic and motor block in the lower part of the body. The main limitation of spinal anesthesia is a variable and relatively short duration of the block with a single-injection of local anesthetic. With appropriate use of adjuvant or combining spinal anesthesia with epidural anesthesia, the analgesic action can be controlled in case of early recovery of initial block or in patients with prolonged procedures. Contraindications are rare. Bleeding disorders and any major dysfunction in coagulation system are rare in children, but spinal anesthesia should not be used in children with local infection or increased intracranial pressure. Children with spinal anesthesia may develop the same adverse effects as has been reported in adults, but in contrast to adults, cardiovascular deterioration is uncommon in children even with high blocks. Most children having surgery with spinal anesthesia need sedation, and in these cases, close monitoring of sufficient respiratory function and protective airway reflexes is necessary. Postdural puncture headache and transient neurological symptoms have been reported also in pediatric patients, and thus, guardians should be provided instructions for follow-up and contact information if symptoms appear or persist after discharge. Epidural blood patch is effective treatment for prolonged, severe headache, and nonopioid analgesic is often sufficient for transient neurological symptoms.

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Section: Contraindications To Spinal Anesthesiamentioning

confidence: 99%

Spinal blocks

Kokki

2011

Pediatric Anesthesia

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“…Suspected nerve injuries occurred following 1 of 364 thoracic, 2 of 1183 lumbar, and 1 of 8493 caudal epidural blocks, with no reported long-term deficits, and children were aged 8 years and above 17 . Isolated cases of neurological deficit following neuraxial anesthesia of varying severity have been reported in neonates 61 and older children 62–65 . The relative contributions of needle trauma, surgical injury, or potential drug-related toxicity to neurological injury are difficult to determine.…”

Section: Clinical Benefits and Risks Of Neuraxial Analgesiamentioning

confidence: 99%

Neuraxial Analgesia in Neonates and Infants

Walker

Yaksh

2012

Anesthesia &Amp; Analgesia

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Neuraxial agents provide robust pain control, have the potential to improve outcomes, and are an important component of the perioperative care of children. Opioids or clonidine improve analgesia when added to perioperative epidural infusions; analgesia is significantly prolonged by addition of clonidine, ketamine, neostigmine or tramadol to single shot caudal injections of local anesthetic; and neonatal intrathecal anesthesia/analgesia is increasing in some centers. However, it is difficult to determine the relative risk-benefit of different techniques and drugs without detailed and sensitive data related to analgesia requirements, side-effects, and follow-up. Current data related to benefits and complications in neonates and infants are summarized, but variability in current neuraxial drug use reflects the relative lack of high quality evidence. Recent preclinical reports of adverse effects of general anesthetics on the developing brain have increased awareness of the potential benefit of neuraxial anesthesia/analgesia to avoid or reduce general anesthetic dose requirements. However, the developing spinal cord is also vulnerable to drug-related toxicity, and although there are well-established preclinical models and criteria for assessing spinal cord toxicity in adult animals, until recently there had been no systematic evaluation during early life. Therefore, the second half of this review presents preclinical data evaluating age-dependent changes in the pharmacodynamic response to different spinal analgesics, and recent studies evaluating spinal toxicity in specific developmental models. Finally, we advocate use of neuraxial agents with the widest demonstrable safety margin and suggest minimum standards for preclinical evaluation prior to adoption of new analgesics or preparations into routine clinical practice.

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“…Epidural analgesia in children is highly effective, safe and provides better postoperative pain control compared with general anesthesia and intravenous opioid analgesia; improved pulmonary function, suppressed hormonal and metabolic stress responses and easy early tracheal extubation (1)(2)(3)(4)(5)(6)14). As with every anesthesia technique, the use of epidural analgesia carries its own risks (15)(16)(17) which must be weighed against the potential advantages.…”

Section: Discussionmentioning

confidence: 99%

Epidural analgesia in the surgery of congenital tracheal stenosis: slide tracheoplasty on cardiopulmonary bypass

Vilà¹,

Marhuenda²,

Gonçalves³

et al. 2006

Pediatric Anesthesia

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Epidural analgesia in children is highly effective and safe; however, it has not enjoyed great popularity in surgery that requires cardiopulmonary bypass. A major concern is the possibility of damage to blood vessels with the epidural needle or catheter and epidural hematoma formation. There seems to be a low incidence of epidural hematoma if certain guidelines are followed, so that in children, epidural analgesia can be used in selected patients, with safety, when surgical repair requires cardiopulmonary bypass. Epidural morphine has been used for clinical pain relief in pediatric cardiac surgery. Improved pulmonary function, suppressed hormonal and metabolic stress responses, easy early tracheal extubation, and good analgesia and sedation that allows neurological examination to alert any possibles hidden complications, are the advantages. A dedicated medical team is essential in the perioperative management to achieve maximum benefit for these patients.

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Intraspinal haematoma following lumbar epidural anaesthesia in a neonate

Cited by 36 publications

References 18 publications

Spinal blocks

Spinal blocks

Neuraxial Analgesia in Neonates and Infants

Epidural analgesia in the surgery of congenital tracheal stenosis: slide tracheoplasty on cardiopulmonary bypass

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