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Chaudhary S, Salhotra R. Subarachnoid block for caesarean section in severe preeclampsia. J Anaesthesiol Clin Pharmacol 2013; 27:169-73. [PMID: 21772674 PMCID: PMC3127293 DOI: 10.4103/0970-9185.81821] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Pregnancy-induced hypertension constitutes a major cause of morbidity and mortality in developing nations and it complicates about 6–8% of pregnancies. Severe preeclampsia poses a dilemma for the anesthesiologist especially in emergency situations where caesarean deliveries are planned for uninvestigated or partially investigated parturients. This article is aimed to review the literature with regards to the type of anesthesia for such situations. A thorough search of literature was conducted on PubMed, EMBASE, and Google to retrieve the articles. Studies on parturients with severe preeclampsia, undergoing caesarean section, were included in this article. There is growing evidence to support the use of subarachnoid block in such situations when the platelet counts are >80,000 mm-3. Better hemodynamic stability with the use of low-dose local anesthetic along with additives and better neonatal outcomes has been found with the use of subarachnoid block when compared to general anesthesia.
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Affiliation(s)
- Sujata Chaudhary
- Department of Anaesthesiology and Critical Care, UCMS and GTB Hospital, Dilshad Garden, Delhi - 110 095, India
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Delayed symptomatic presentation of epidural hematoma after epidural catheter anesthesia: case report. Spine (Phila Pa 1976) 2007; 32:E649-51. [PMID: 18090075 DOI: 10.1097/brs.0b013e31815743e2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The authors present a case report of a 70-year-old woman who presented with delayed symptoms of epidural hematoma after epidural catheter anesthesia. OBJECTIVE We intend to report a unique case of delayed presentation of epidural hematoma after epidural catheter anesthesia. SUMMARY OF BACKGROUND DATA The authors present a case of a 70-year-old woman who received epidural anesthesia via spinal catheter infusion before right knee replacement surgery. After an unremarkable postoperative course, she presented 6 weeks later with worsening middle and lower back pain, prompting a workup and lumbar MR imaging. MRI of her lumbar spine demonstrated a lower thoracic epidural fluid collection with significant radiographic mass effect on the thoracic spine. The fluid was diagnosed as chronic breakdown of an initially asymptomatic epidural hematoma. Symptomatic epidural hematoma formation after epidural block is rare but commonly reported in the literature. The incidence of asymptomatic hematoma formation is probably much higher and unrecognized. METHODS This is a retrospective review of a case seen at our institution. RESULTS A persistent epidural fluid collection in a normocoagulable patient presenting with symptoms of back pain more than a month after spinal block has not been reported in the literature. CONCLUSION In the absence of focal neurologic symptoms, conservative therapy and observation are appropriate.
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Affiliation(s)
- Yaakov Beilin
- Department of Anesthesiology and Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai School of Medical New York, New York 10029-6579, USA.
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Miyazaki M, Takasita M, Matsumoto H, Sonoda H, Tsumura H, Torisu T. Spinal epidural hematoma after removal of an epidural catheter: case report and review of the literature. ACTA ACUST UNITED AC 2006; 18:547-51. [PMID: 16306849 DOI: 10.1097/01.bsd.0000128692.44276.cf] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of spinal epidural hematoma after removal of an epidural catheter. The patient had no background of anticoagulant therapy or coagulopathy; sudden severe back pain occurred immediately after removal of the catheter. The chance of this occurring is estimated to be between 1:150,000 and 1:190,000. We studied 40 previous reports from 1952 to 2000, and we also investigated anticoagulant therapy and pathologic states, puncture difficulties and bleeding at the point of insertion, and its onset. In 23 cases (57.5%), anticoagulant therapy had been performed, and in 5 cases (12.5%), coagulopathy or liver dysfunction had been recognized. In 20 cases (50%), the initial symptoms were recognized within 24 hours after removal of the epidural catheter. Although spinal epidural hematoma is a very rare condition, it is a serious complication of continuous epidural anesthesia.
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MESH Headings
- Aged
- Anesthesia, Epidural/adverse effects
- Back Pain/diagnosis
- Back Pain/etiology
- Catheterization/adverse effects
- Female
- Hematoma, Epidural, Spinal/diagnosis
- Hematoma, Epidural, Spinal/etiology
- Hematoma, Epidural, Spinal/therapy
- Humans
- Spinal Cord Injuries/diagnosis
- Spinal Cord Injuries/etiology
- Spinal Cord Injuries/therapy
- Wounds, Penetrating/diagnosis
- Wounds, Penetrating/etiology
- Wounds, Penetrating/therapy
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Oita Medical University, Oita, Japan.
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Abramovitz S, Beilin Y. Thrombocytopenia, low molecular weight heparin, and obstetric anesthesia. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2003; 21:99-109. [PMID: 12698835 DOI: 10.1016/s0889-8537(02)00033-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The parturient with coagulation defects, whether related to thrombocytopenia or to anticoagulation therapy, presents a unique challenge to the anesthesiologist. The risk of spinal or epidural hematoma in these patients has not been quantified fully but is a factor that one must consider on a case-by-case basis in determining whether neuraxial anesthesia is appropriate for the parturient. Following the guidelines set forth in this article should help reduce the risk of spinal or epidural hematoma without sacrificing the quality of care provided to patients.
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Affiliation(s)
- Sharon Abramovitz
- Department of Anesthesiology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
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Stoll A, Sanchez M. Epidural hematoma after epidural block: implications for its use in pain management. SURGICAL NEUROLOGY 2002; 57:235-40. [PMID: 12173390 DOI: 10.1016/s0090-3019(02)00639-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Spinal epidural hematoma after spinal puncture such as for injection of steroids for pain management may result in a rare complication of a spinal epidural hematoma causing acute myelopathy. Although this complication is well known with epidural anesthesia, where it is usually seen with impaired hemostasis, there are surprisingly few case reports of epidural hematoma after an epidural steroid block. CASE DESCRIPTION A healthy 34-year-old man with no evidence of coagulopathy and not taking antiplatelet medication suddenly had onset of acute cervical myelopathy from a large cervical epidural hematoma 8 days after a cervical epidural steroid block. Following prompt surgical evacuation of the clot, the patient made a near complete recovery. CONCLUSION Spinal epidural hematoma after spinal puncture is usually associated with impaired hemostasis. This case illustrates that it may occur in the absence of known risk factors. The delayed onset and the absence of risk factors have implications for the use of this procedure in chronic pain management.
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Affiliation(s)
- Amos Stoll
- Department of Surgery-Section of Neurosurgery, Broward General Medical Center, Ft. Lauderdale, Florida, USA
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Goldstein S, Dean D, Kim SJ, Cocozello K, Grofsik J, Silver P, Cody RP. A survey of spinal and epidural techniques in adult cardiac surgery. J Cardiothorac Vasc Anesth 2001; 15:158-68. [PMID: 11312472 DOI: 10.1053/jcan.2001.21937] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine if a significant number of anesthesiologists are performing spinal and epidural techniques in adults undergoing cardiac surgery and if any neurologic injuries have been associated with these techniques. DESIGN Anonymous survey of clinical practice. SETTING Data collected via mail from members of the Society of Cardiovascular Anesthesiologists. PARTICIPANTS Attending anesthesiologists. INTERVENTIONS Anesthesiologists completed an anonymous survey of their use of spinal and epidural techniques in adult patients undergoing cardiac surgery. MEASUREMENTS AND MAIN RESULTS Of 3974 anesthesiologists, 974 (24%) responded to the questionnaire; 892 are at institutions that perform cardiac surgery. Of the 892 responders, 68 (7.6%) reported they use spinal techniques, whereas 62 (7%) reported they use epidural techniques. Nine (1%) anesthesiologists reported they use both techniques. There were no reports of neurologic complications related to the use of spinal or epidural techniques performed by the anesthesiologists responding to the survey. CONCLUSIONS A significant number of anesthesiologists are performing spinal and epidural techniques in adult patients undergoing cardiac surgery. Prospective, controlled trials should be performed to evaluate the benefits and risks of spinal and epidural techniques in this population.
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Affiliation(s)
- S Goldstein
- Department of Anesthesia, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Abstract
Complications after spinal or epidural anesthesia are rare. We report 2 cases of postoperative, complete paraplegia after regional anesthesia in orthopaedic patients not on anticoagulants. The paralysis was likely the result of spinal cord compression secondary to an epidural hematoma in 1 case and subdural hematoma in 1 case. A review of the literature regarding complications of regional anesthesia is presented. Regional anesthesia should be administered with caution and in selected patients.
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Affiliation(s)
- C C Stroud
- Union Memorial Hospital, Baltimore, Maryland, USA
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Osmani O, Afeiche N, Lakkis S. Paraplegia after epidural anesthesia in a patient with peripheral vascular disease: case report and review of the literature with a description of an original technique for hematoma evacuation. JOURNAL OF SPINAL DISORDERS 2000; 13:85-7. [PMID: 10710156 DOI: 10.1097/00002517-200002000-00016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epidural hematoma after epidural anesthesia is a rare and uncommon complication in patients with peripheral vascular disease who require perioperative anticoagulation therapy. A low index of suspicion makes its diagnosis difficult and often delayed. Treatment usually involves extensive laminectomy, increasing the chances for patient complications. In this article, the authors report a case of epidural hematoma with secondary paraplegia after epidural anesthesia. Also described is an original technique for evacuating the epidural space.
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Affiliation(s)
- O Osmani
- Spine and Paediatric Orthopaedics, American University of Beirut, Lebanon
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Beilin Y, Zahn J, Comerford M. Safe epidural analgesia in thirty parturients with platelet counts between 69,000 and 98,000 mm(-3). Anesth Analg 1997; 85:385-8. [PMID: 9249118 DOI: 10.1097/00000539-199708000-00025] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Regional anesthesia is a popular form of pain relief for the management of labor and delivery. Thrombocytopenia is considered a relative contraindication to the administration of regional anesthesia. Some authorities have recommended that an epidural anesthetic be withheld if the platelet count is <100,000 mm(-3). For the period of March 1993 through February 1996, we reviewed the charts of all parturients who had a platelet count <100,000 mm(-3) during the peripartum period. Eighty women met this criterion. Of these 80, 30 had an epidural anesthetic placed when the platelet count was <100,000 mm(-3) (range 69,000-98,000 mm(-3)), 22 had an epidural anesthetic placed with a platelet count >100,000 mm(-3) that subsequently decreased below 100,000 mm(-3), and 28 did not receive a regional anesthetic. We found no documentation of any neurologic complications in the medical records. We conclude that regional anesthesia should not necessarily be withheld when the platelet count is <100,000 mm(-3).
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MESH Headings
- Analgesia, Epidural
- Analgesia, Obstetrical
- Anesthesia, Epidural
- Anesthesia, Obstetrical
- Anesthetics, Local/administration & dosage
- Blood Coagulation Tests
- Bupivacaine/administration & dosage
- Cesarean Section
- Contraindications
- Delivery, Obstetric
- Female
- Humans
- Incidence
- Labor, Obstetric
- Lidocaine/administration & dosage
- Nervous System Diseases/etiology
- Obstetrical Forceps
- Platelet Count
- Pre-Eclampsia/physiopathology
- Pregnancy
- Pregnancy Complications, Hematologic/physiopathology
- Pregnancy Complications, Infectious/physiopathology
- Purpura, Thrombocytopenic, Idiopathic/physiopathology
- Retrospective Studies
- Thrombocytopenia/physiopathology
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Affiliation(s)
- Y Beilin
- Department of Anesthesiology, Mount Sinai School of Medicine, New York, New York, USA
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Beilin Y, Zahn J, Comerford M. Safe Epidural Analgesia in Thirty Parturients with Platelet Counts Between 69,000 and 98,000 mm-3. Anesth Analg 1997. [DOI: 10.1213/00000539-199708000-00025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
PURPOSE Haematoma formation in the spinal canal due to epidural anaesthesia is a very rare but serious complication. This paper presents a comprehensive review of case reports. SOURCE Sampling of case reports over a 10 yr period, medline-research (1966-1995) and cross-check with former reviews. FINDINGS Fifty-one confirmed spinal haematomas associated with epidural anaesthesia were found. Most were related to the insertion of a catheter, a procedure that was graded as difficult or traumatic in 21 patients. Other risk factors were: fibrinolytic therapy (n = 2), previously unknown spinal pathology (n = 2), low molecular weight heparin (n = 2), aspirin or other NSAID (n = 3), epidural catheter inserted during general anaesthesia (n = 3), thrombocytopenia (n = 5), ankylosing spondylitis (n = 5), preexisting coagulopathy (n = 14), and intravenous heparin therapy (n = 18). CONCLUSION Coagulopathies or anticoagulant therapy (e.g., full heparinization) were the predominant risk factors, where-as low-dose heparin thromboprophylaxis or NSAID treatment was rarely associated with spinal bleeding complications. Ankylosing spondylitis was identified as a new, previously unreported risk factor. Analysis of reported clinical practice suggests an incidence of haematoma of 1:190,000 epidurals.
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Affiliation(s)
- H Wulf
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Christian-Albrechts-University of Kiel, Germany.
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Oda Y, Terai T, Yukioka H, Fujimori M. A Case of Herpes Zoster Myelitis Occurring During Epidural Analgesia. Anesth Analg 1995. [DOI: 10.1213/00000539-199509000-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Oda Y, Terai T, Yukioka H, Fujimori M. A case of herpes zoster myelitis occurring during epidural analgesia. Anesth Analg 1995; 81:646-8. [PMID: 7653839 DOI: 10.1097/00000539-199509000-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Y Oda
- Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Japan
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Lao TT, Halpern SH, MacDonald D, Huh C. Spinal subdural haematoma in a parturient after attempted epidural anaesthesia. Can J Anaesth 1993; 40:340-5. [PMID: 8485794 DOI: 10.1007/bf03009633] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We report a case of spinal subdural haematoma with neurological deficit in a 36-yr-old woman following Caesarean section for severe preeclampsia and placental abruption. She had been taking chronic trifluoperazine treatment for depression. Her activated partial thromboplastin time (aPTT) was 49 sec (normal = 26-36) but all other tests of coagulation were normal. Epidural anaesthesia was attempted but, despite a negative test dose, injection of local anaesthetic resulted in a generalized seizure and general anaesthesia was induced. Seventy-two hours after delivery, she was found to have bilateral leg weakness, urinary incontinence, absent rectal sphincter tone and asymmetrical leg reflexes. The diagnosis of spinal haematoma was confirmed by magnetic resonance imaging. She underwent emergency laminectomy and made a full neurological recovery.
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Affiliation(s)
- T T Lao
- Department of Obstetrics and Gynaecology, Women's College Hospital, University of Toronto, Ontario
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Vandermeulen EP, Vermyelen J, Van Aken H. Epidural and spinal anaesthesia in patients receiving anticoagulant therapy. ACTA ACUST UNITED AC 1993. [DOI: 10.1016/s0950-3501(05)80276-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kimura Y, Chuma R, Shirakawa J, Obara H. Spontaneous remission of epidural hematoma following continuous epidural anesthesia. J Anesth 1990; 4:370-4. [PMID: 15235973 DOI: 10.1007/s0054000040370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/1990] [Accepted: 05/30/1990] [Indexed: 10/26/2022]
Affiliation(s)
- Y Kimura
- Department of Anesthesiology, Kobe University, School of Medicine, Kobe, Japan
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