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Epidural and Intrathecal Analgesia
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
The onset of signs and symptoms of an epidural hematoma after placement or removal of an epidural catheter may be sudden (Horlocker, 2011). In many patients a neurological deficit (especially muscle weakness) may be the first indication of a hematoma. Increasing neurological dysfunction (motor, sensory, bladder, or bowel) develops as the hematoma increases in size and compresses nerve roots and the spinal cord. The patient may also complain of sharp back or nerve root pain. Immediately after epidural or spinal anesthesia, a hematoma may present as an unusually dense or patchy block or one that is unusually slow to resolve.
Anesthesia and Analgesia in the Pregnant Cardiac Patient
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
The most common reasons that a neuraxial technique may not be possible include conditions that increase the risks of the technique causing bleeding, infection, or nerve damage in the patient's spine. In cardiac disease patients, anticoagulation therapy may preclude the ability to perform any neuraxial anesthetic techniques. Although the incidence of epidural hematoma is rare, the consequences can be devastating. Therefore, anesthesiologists are guided by the American Society of Regional Anesthesia and the Society for Obstetric Anesthesia and Perinatology consensus statements in their management of anticoagulation and neuraxial techniques [13,14]. These guidelines are summarized in Figures 8.1 and 8.2. If a patient does not meet the criteria for safe placement, anesthesiologists will not perform a labor analgesic or surgical anesthetic neuraxial technique.
How to perform revision lumbar decompression
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Jacob Hoffman, Ryan Murphy, Mark L. Prasarn, Shah-Nawaz M. Dodwad
Following spinal surgery, patients are at risk for thromboembolic events, including deep venous thrombosis (DVT) and pulmonary embolism. Surgeons must weigh the risk of epidural hematoma with the risk of a thromboembolic event in terms of chemoprophylaxis. In the preoperative holding area, thigh-high compressive stockings and sequential compressive device sleeves are placed on the patient and used throughout the procedure. In elective decompressions, patients are encouraged to mobilize and use incentive spirometry during the postoperative period. Venous thromboembolic chemoprophylaxis is used in high-risk patients approximately 24 hours postoperatively. A symptomatic epidural hematoma should be diagnosed promptly and the patient emergently returned to the OR for decompression.
A case of spontaneous spinal epidural hematoma mimicking transient ischemic attack
Published in International Journal of Neuroscience, 2022
Cong Liu, Xiuli Liu, Yan Liu, Guomei Ma, Hui Li, Jingzhe Han, Yi Xiang
The precise etiology of SSEH remains unclear. Increasing age, hypertension, anticoagulants, thrombolytics, antiplatelet agents, vascular malformation, and systemic diseases have been considered as possible predisposing factors in some patients with SSEH [3–6].The etiology of SSEH in this patient may have been related to the increased blood pressure and the usual use of oral aspirin. SSEH is more common in the cervicothoracic and thoracolumbar segments, and is slightly more common in men than in women because of the close ventral and vertebral bodies. Epidural hematoma mostly occurs in the dorsal side, typically manifested as sudden back tingling and symptoms of spinal cord or nerve compression, followed by different degrees of motor and/or sensory impairment below the pain site, and in severe cases it may develop into total paralysis. There are also a few patients who do not present the above typical symptoms, which can mimic rare manifestations such as stroke attacks and Brown-Sequard syndrome [7, 8], leading to a high rate of clinical misdiagnosis.
Labor epidural analgesia with severe thrombocytopenia
Published in Baylor University Medical Center Proceedings, 2022
Sagar Patel, Kara Bennett, Weike Tao
While the American Society of Anesthesiologists and American College of Obstetricians and Gynecologists recommend no routine platelet counts in healthy women, preeclampsia may occur with mild or no symptoms. At times, the choice whether to perform neuraxial analgesia/anesthesia when there is no time to obtain a platelet count is made as an individualized decision. In our case, while the lab value was not available at the time of preanesthetic evaluation, a review of lab values immediately before epidural placement would have avoided the situation described. Furthermore, our encounter also supports the estimate by Lee et al that even with a platelet count <50,000/mm3, the risk of an epidural hematoma remains low at 0% to 11%.5 There have been a handful of reports of uneventful epidural analgesia in the setting of severe thrombocytopenia.6–8 In our case, epidural placement was performed at 32,000/mm3, but the lowest platelet count during her labor course was 21,000/mm3. Our report may contribute to the scant evidence currently available regarding the risk of epidural hematoma with insertion and removal of the epidural catheter in extreme thrombocytopenia.
Retrospective study of functional outcomes and disability after non-ischaemic vascular causes of spinal cord dysfunction
Published in The Journal of Spinal Cord Medicine, 2021
Chiu Pin Teo, Kevin Cheng, Peter Wayne New
More than half of our cases had an iatrogenic contribution to their non-ischemic vascular SCDys. We presented six different spinal procedures leading to SCDys, but further subgroup analysis on their rehabilitation outcome differences was not performed due to the small sample size. The causative anticoagulant reported in our study was warfarin, and no cases were identified as involving aspirin. Numerous case reports describe the correlation between spinal cord hemorrhage and warfarin,13–23 and as early as in 1956.24 A review of nine published cases reported minimal or no recovery following surgery for warfarin-associated spinal cord hemorrhage.22 No novel oral anticoagulant agent caused spinal cord hemorrhage in our study. These agents were first introduced in Australia in 2013, and we ended our data collection two years later. Cases of spinal cord hemorrhage related to rivaroxaban, a factor Xa inhibitor, have been reported.25–29 Two were epidural hematoma and reported complete neurological recovery.25,26 Another two were due to subdural hematoma, with no neurological improvement after six months,27,28 and one subdural hematoma, with marked but incomplete recovery.29