Safe Epidural Analgesia in Thirty Parturients with Platelet Counts Between 69,000 and 98,000 mm-3

Beilin, Yaakov; Zahn, Jeffrey; Comerford, Michele

doi:10.1097/00000539-199708000-00025

Cited by 66 publications

(39 citation statements)

References 12 publications

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“…Beilin, et al in their retrospective review reported safe epidural analgesia in thirty parturients with platelet counts between 69,000 and 98,000 per microliter [9].…”

Section: Discussionmentioning

confidence: 99%

“…Very few cases were associated with thrombocytopenia alone [8][9][10]. Different causes of thrombocytopenia may have different risks of bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Pseudo-thrombocytopenia must be excluded. A manual platelet count is more accurate in patients with recent thrombocytopenia because automated counters are not reliable at low platelet counts [9].…”

Section: Discussionmentioning

confidence: 99%

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Uneventful Spinal Anesthesia in a Patient with Precipitous Drop of Platelet Secondary to HELLP Syndrome: A Case Report and Review of Literatures

Liu¹,

Li²,

Wang³

2012

OJAnes

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Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in preeclampsia parturients can be associated with substantial maternal and neonatal morbidity. Data on the issue of the safety of neuraxial anesthesia with thrombocytopenia in HELLP syndrome is limited. A lower limit of 100,000 per microliter for platelet count was suggested as "safe" for performing neuraxial anesthesia, however there is no supporting data. This lower limit is challenged lately. We present a case of uneventful spinal anesthesia for urgent Cesarean section in a patient with severe pre-eclamsia, HELLP syndrome and precipitous platelet drop from 230,000 to 42,000 per microliter.

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“…Beilin, et al in their retrospective review reported safe epidural analgesia in thirty parturients with platelet counts between 69,000 and 98,000 per microliter [9].…”

Section: Discussionmentioning

confidence: 99%

“…Very few cases were associated with thrombocytopenia alone [8][9][10]. Different causes of thrombocytopenia may have different risks of bleeding.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Uneventful Spinal Anesthesia in a Patient with Precipitous Drop of Platelet Secondary to HELLP Syndrome: A Case Report and Review of Literatures

Liu¹,

Li²,

Wang³

2012

OJAnes

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“…77 A PC of 50,000·µL -1 is sufficient for spinal anesthesia whereas a minimum PC of 80,000·µL -1 has been proposed for epidural anesthesia. [78][79][80][81][82] It may be difficult to assess the effectiveness of platelet transfusions. One platelet concentrate usu-ally produces an increase of about 7,000 to 10,000 platelets·mm -3 one hour after transfusion in a 70-kg adult.…”

Section: Risk Of Perioperative Bleeding If Antiplatelet Medications Amentioning

confidence: 99%

Brief review: Coronary drug-eluting stents and anesthesia

Dalal

Stanlies

Souza

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Anesthesiologists managing patients with drug-eluting stents (DES) face the challenge of balancing the risks of bleeding vs perioperative stent thrombosis (ST). This article reviews DES and the influence of antiplatelet medications related to their use. A perioperative management algorithm is suggested. Novel P2Y12 antagonists currently under investigation, including cangrelor and prasugrel are considered, as well as their potential role in modification of perioperative cardiovascular risks and management of patients with DES.Source: A PubMed search of the relevant literature over the period 1985-2005 was undertaken using the terms "drug-eluting stent", "coronary artery stent", "bare metal stent", "antiplatelet medication", "aspirin", "clopidogrel."Principal findings: Delayed re-endothelialization may render both sirolimus-eluting and paclitaxel-eluting stents susceptible to thrombosis for a longer duration than bare metal stents. Stent thrombosis may be associated with resistance to antiplatelet medication. In patients with a DES, a preoperative cardiology consultation is essential. Elective surgery should be postponed if the duration between DES placement and noncardiac surgery is less than six months. For semi-emergent procedures, both aspirin and clopidogrel should be continued during surgery unless clearly contraindicated by the nature of the surgery. If the risk of bleeding is high, then modification of antiplatelet medications should be considered on a case-by-case basis. Conclusion: A profound increase in the number of patients with DES requires anesthesiologists to be familiar with their associated antiplatelet medications, and strategies for risk modification of ST and possible hemorrhagic complications in the perioperative setting. Objectif

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“…4,[12][13][14][15] More information is needed to determine the safety of epidural analgesia in the presence of thrombocytopenia. Investigations have shown that the bleeding time does not predict bleeding in remote sites (e.g., the epidural space) and its use has dropped significantly.…”

Section: Patient Education and Consent For Labour Analgesiamentioning

confidence: 99%

Obstetric anesthesia practice in Canada

Breen

McNeil

Dierenfield

2000

Can J Anesth/J Can Anesth

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Purpose: To describe obstetric anesthesia in Canada as practiced in 1997: to identify practices at variance with the literature and the opinions of experts: and to identify questions for future research.Methods: In 1997, a detailed postal questionnaire asking about the practice of obstetric anesthesia was mailed to all 1,539 specialist anesthesiologist members of the Canadian Anaesthetists' Society residing in Canada. Nonresponders were mailed a second questionnaire three months later.Results: There were 865 completed questionnaires returned for analysis (56.2%). Of these, 522 anesthesiologists practiced obstetric anesthesia (60.3%). The data were subdivided into those from anesthesiologists with a full or part-time university based practice (40.1%) and those from a community based practice (59.9%). University based and community-based anesthesiologists have very similar patterns of practice. Specific areas where anesthesia practice was different from current recommendations included: (1) information provided when obtaining consent for labour epidural analgesia, (2) use of opioids and local anesthetics for initiation of epidural analgesia, (3) use of coagulation testing in preeclampsia, (4) the common use of cutting spinal needles, (5) use of neuraxial morphine and nonsteroidal anti-inflammatory agents after Cesarean deliveries, (6) optimal treatment of neuraxial opioid side effects, (7) when to insert an endotracheal tube for general anesthesia after delivery, and (8) withdrawing epidural catheters through epidural needles.Conclusions: This survey presents reference data on the practice of obstetric anesthesia in Canada in 1997. Anesthesiologists with university affiliation have very similar practices to those without university affiliations.Objectif: Décrire l'anesthésie obstétricale pratiquée au Canada en 1997; identifier les pratiques qui diffèrent des pratiques documentées et des opinions d'experts et proposer des sujets de recherches ultérieures.Méthode : En 1997, un questionnaire détaillé sur la pratique de l'anesthésie obstétricale a été posté aux 1 539 anesthésiologistes membres de la Société canadienne des anesthésiologistes résidant au Canada. Trois mois plus tard, un second questionnaire a été posté à ceux qui n'avaient pas encore répondu.Résultats : Il y a eu 865 questionnaires remplis et analysés (56,2 %). De ce nombre, 522 provenaient d'anesthé-siologistes pratiquant l'anesthésie obstétricale (60,3 %). Les données ont été subdivisées selon le lieu de pratique, en milieu universitaire à temps complet ou partiel (40,1 %) ou en d'autres centres (59,9 %). Les modèles de pratique étaient très similaires. Certaines activités spécifiques différaient des recommandations courantes : 1) l'information fournie pour obtenir le consentement à l'analgésie épidurale pendant le travail, 2) l'usage d'opioïdes et d'anesthésiques locaux pour amorcer l'analgésie épidurale, 3) l'utilisation d'épreuve de coagulation en préé-clampsie, 4) l'usage courant d'aiguilles rachidiennes tranchantes, 5) l'administration neuraxiale...

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Safe Epidural Analgesia in Thirty Parturients with Platelet Counts Between 69,000 and 98,000 mm-3

Cited by 66 publications

References 12 publications

Uneventful Spinal Anesthesia in a Patient with Precipitous Drop of Platelet Secondary to HELLP Syndrome: A Case Report and Review of Literatures

Uneventful Spinal Anesthesia in a Patient with Precipitous Drop of Platelet Secondary to HELLP Syndrome: A Case Report and Review of Literatures

Brief review: Coronary drug-eluting stents and anesthesia

Obstetric anesthesia practice in Canada

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