Spinal Epidural Hematoma after Spinal Anesthesia in a Patient Treated with Clopidogrel and Enoxaparin

Litz, R. J.; Gottschlich, Birgit; Stehr, Sebastian

doi:10.1097/00000542-200412000-00030

Cited by 41 publications

(23 citation statements)

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“…[7][8][9][10] The responsiveness to aspirin and clopidogrel and recovery of platelet function after discontinuation of treatment show considerable variability. [11][12][13][14] This may be due to patient's compliance, genetic factors, comorbidities, inflammation, plasma fibrinogen concentration, and/or comedication.…”

Section: Preexisting Antiplatelet Therapymentioning

confidence: 99%

Pain-associated Respiratory Failure in Chest Trauma

et al. 2013

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T he leading cause of death in young people is trauma. Chest trauma has high associated mortality, thus diagnosis and treatment need to be addressed early on presentation. 1 The incidence of rib fractures range from 10% to 26% in traumatic thoracic injury and the number of rib fractures independently predict patients' pulmonary morbidity and mortality.2 Numerous cardiopulmonary to neurologic causes such as tamponade, hemo-pneumothorax, and cervical spine injury can be implicated ( fig. 1). Severe respiratory distress can also result from breathing-dependent pain where parenteral opioids are often insufficient in addressing the pain and associated respiratory failure.3 epidural analgesia is associated with reduction in mortality for all patients with multiple rib fractures but is underused, in part due to the potential risks of epidural hematomas. 2,4 Variables that alter the risk of bleeding including age and sex, comorbidities such as diabetes and liver cirrhosis, severity of trauma and degree of resuscitation, and anticoagulation or antiplatelet therapy must also be considered.We describe a patient under clopidogrel therapy presenting to the intensive care unit (ICU) with severe respiratory distress that improved with epidural analgesia. We provide a discussion of the risks and benefits of neuraxial analgesia in patients presenting with rib-fracture pain-related respiratory failure. Case ReportA 79-yr-old man with a history of chronic obstructive pulmonary disease, bronchiectasis, coronary artery disease postplacement of bare-metal stent several years ago, hypertension, and diabetes was transferred to our hospital shortly after motor-vehicle collision. home medications were aspirin 325 mg, clopidogrel 75 mg per day (taken morning of accident), as well as inhaled tiotropium, inhaled fluticasone/ salmeterol, albuterol, isosorbide dinitrate, metformin, and simvastatin. On arrival, the patient was hemodynamically stable with pulse oximeter saturations of 94% on a nonrebreather mask with 60% inspired oxygen concentration. Computed tomography imaging revealed second to ninth anterior right rib fractures, fourth through ninth anterior left rib fractures, and posterior 10th and 11th left rib fractures, but without flail chest nor pneumothorax. A small left pleural effusion, left lung and lingular atelectasis, and minimal ground glass opacity in the right upper lobe, and a small right-lower lobe pulmonary contusion were shown ( fig. 2). The patient received 3 l lactated Ringer's solution before arriving in our ICU. his Injury Severity Score of 24 was primarily due to rib and lung injuries (16 points), then moderate head and surface injuries (4 points each).After admission to the surgical ICU, he developed increasing pain-related respiratory distress during the day. Tylenol was administered, and hydromorphone 0.2 mg intravenously produced somnolence, but minimal improvement of respiratory effort and pain. he had an electrocardiogram unremarkable for cardiac ischemia and negative cardiac isoenzymes and brain-natriuertic ...

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Section: Preexisting Antiplatelet Therapymentioning

confidence: 99%

Pain-associated Respiratory Failure in Chest Trauma

et al. 2013

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“…They have been reported to occur spontaneously, in association with spinal metastasis, after epidural anesthesia or spinal manipulation and after spinal surgery. [5][6][7][8][9][10][11][12] Postoperative SEHs usually present with rapidly progressive neurologic deterioration. Neurologic recovery is dependent on existing neurologic function, and the time elapsed until surgical decompression.…”

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confidence: 99%

Does Preoperative DVT Chemoprophylaxis in Spinal Surgery Affect the Incidence of Thromboembolic Complications and Spinal Epidural Hematomas?

Cunningham

Swamy

Thomas

2011

Journal of Spinal Disorders &Amp; Techniques

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“…Delay prior to surgery resulted in a higher rate of spinal anesthesia compared to no delay (eight vs. three). This may be due to reports of epidural hematoma when spinal anesthesia has been performed on patients who take clopidogrel [18][19][20]. It is often suggested that PFF patients often ''look better'' following regional anesthesia compared to general anesthesia.…”

Section: Discussionmentioning

confidence: 99%