martes, 21 de febrero de 2017

Hematoma neuraxial y anestesia regional/ Neuraxial hematoma and regional anesthesia

Febrero 21, 2017. No. 2607

Hematoma espinal subdural con síndrome de cauda equina: Complicación de anestesia espinal-epidural combinada
Spinal subdural hematoma with cauda equina syndrome: A complication of combined spinal epiduralanesthesia.
J Anaesthesiol Clin Pharmacol. 2015 Apr-Jun;31(2):244-5. doi: 10.4103/0970-9185.155158.Abstract
Combined spinal-epidural anesthesia (CSE) is considered safe in lower limb surgeries. We report a case of sudden neurological deterioration in a stable postoperative patient who was given CSE for total knee replacement and low molecular weight heparin in postoperative period. On the 4(th) postoperative day, she developed sudden onset weakness in left lower limb along with bladder incontinence. Magnetic resonance imaging spine revealed a subdural hematoma at L2-L3 level. Immediate laminectomy along with cord decompression was done and patient recovered well except for a persistent foot drop on left side.
KEYWORDS:Cauda equina syndrome; combined spinal epidural anesthesia; epidural analgesia; subdural hematoma

Uso de plaquetas antes de punciones lumbares o anestesia epidural para la prevención de complicaciones en pacientes con trombocitopenia
Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia.
Cochrane Database Syst Rev. 2016 May 24;(5):CD011980. doi: 10.1002/14651858.CD011980.pub2.
BACKGROUND:People with a low platelet count (thrombocytopenia) often require lumbar punctures or an epidural anaesthetic. Lumbar punctures can be diagnostic (haematological malignancies, epidural haematoma, meningitis) or therapeutic (spinal anaesthetic, administration of chemotherapy). Epidural catheters are placed for administration of epidural anaesthetic. Current practice in many countries is to correct thrombocytopenia with platelet transfusions prior to lumbar punctures and epiduralanaesthesia, in order to mitigate the risk of serious procedure-related bleeding. However, the platelet count threshold recommended prior to these procedures varies significantly from country to country. This indicates significant uncertainty among clinicians of the correct management of these patients. The risk of bleeding appears to be low but if bleeding occurs it can be very serious (spinal haematoma). Therefore, people may be exposed to the risks of a platelet transfusion without any obvious clinical benefit. OBJECTIVES: To assess the effects of different platelet transfusion thresholds prior to a lumbar puncture or epidural anaesthesia in people with thrombocytopenia (low platelet count). SEARCH METHODS: We searched for randomised controlled trials (RCTs) in CENTRAL (The Cochrane Library 2016, Issue 3), MEDLINE (from 1946), EMBASE (from 1974), the Transfusion Evidence Library (from 1950) and ongoing trial databases to 3 March 2016. SELECTION CRITERIA: We included RCTs involving transfusions of platelet concentrates, prepared either from individual units of whole blood or by apheresis, and given to prevent bleeding in people of any age with thrombocytopenia requiring insertion of a lumbar puncture needle or epidural catheter. We only included RCTs published in English. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We identified no completed or ongoing RCTs in English. We did not exclude any completed or ongoing RCTs because they were published in another language.
AUTHORS' CONCLUSIONS: There is no evidence from RCTs to determine what is the correct platelet transfusion threshold prior to insertion of a lumbar puncture needle or epidural catheter. There are no ongoing registered RCTs assessing the effects of different platelet transfusion thresholds prior to the insertion of a lumbar puncture or epidural anaesthesia in people with thrombocytopenia. Any future RCT would need to be very large to detect a difference in the risk of bleeding. We would need to design a study with at least 47,030 participants to be able to detect an increase in the number of people who had major procedure-related bleeding from 1 in 1000 to 2 in 1000.
Recuperación espontánea de paraplegia producida por hematoma epidural después de retirar el catéter peridural
Spontaneous recovery of paraplegia caused by spinal epidural hematoma after removal of epidural catheter.
Case Rep Anesthesiol. 2014;2014:291728. doi: 10.1155/2014/291728. Epub 2014 May 5.
We report a patient who developed paraplegia caused by a spinal epidural hematoma after removal of an epidural catheter, which resolved spontaneously. A 60-year-old woman underwent thoracoscopic partial resection of the left lung under general anesthesia combined with epidural anesthesia. She neither was coagulopathic nor had received anticoagulants. Paraplegia occurred 40 minutes after removal of the epidural catheter on the first postoperative day. Magnetic resonance images revealed a spinal epidural hematoma. Surgery was not required as the paraplegia gradually improved until, within 1 hour, it had completely resolved. Hypoesthesia had completely resolved by the third postoperative day.

Hematoma epidural secundario a anestesia espinal. Tratamiento conservador
M. Bermejo1 , E. Castañón1 , P. Fervienza1 , F. Cosío1 , M. Carpintero1 y M. L. Díaz-Fernández1
Rev. Soc. Esp. Dolor 11: 452-455, 2004

Hematoma subdural-epidural grande, espontáneo después de anestesia peridural para cesárea. Manejo conservador con evolución excelente
Large, spontaneous spinal subdural-epidural hematoma after epidural anesthesia for caesarean section: Conservative management with excellent outcome.
Surg Neurol Int. 2016 Sep 22;7(Suppl 25):S664-S667. eCollection 2016.
BACKGROUND:Iatrogenic or spontaneous spinal hematomas are rarely seen and present with multiple symptoms that can be difficult to localize. Most spontaneous spinal hematomas are multifactorial, and the pathophysiology is varied. Here, we present a case of a scattered, multicomponent, combined subdural and epidural spinal hematoma that was managed conservatively. CASE DESCRIPTION: A 38-year-old woman came to the emergency department (ED) complaining of severe neck and back pain. She had undergone a caesarean section under epidural anesthesia 4 days prior to her arrival in the ED. She was placed on heparin and then warfarin to treat a pulmonary embolism that was diagnosed immediately postpartum. Her neurological examination at presentation demonstrated solely the existence of clonus in the lower extremities and localized cervical and low thoracic pain. In the ED, the patient's international normalized ratio was only mildly elevated. Spinal magnetic resonance imaging revealed a large thoracolumbar subdural hematoma with some epidural components in the upper thoracic spine levels. Spinal cord edema was also noted at the T6-T7 vertebral level. The patient was admitted to the neurosurgical intensive care unit for close surveillance and reversal of her coagulopathy. She was treated conservatively with pain medication, fresh frozen plasma, and vitamin K. She was discharged off of warfarin without any neurological deficit. CONCLUSIONS: Conservative management of spinal hematomas secondary to induced coagulopathies can be effective. This case suggests that, in the face of neuroimaging findings of significant edema and epidural blood, the clinical examination should dictate the management, especially in such complicated patients.
KEYWORDS: Caesarean section; hematoma; intensive care unit; subdural-epidural

Hematoma epidural después de inyección epidural de esteroides
Epidural hematoma after routine epidural steroid injection.
Surg Neurol Int. 2016 May 6;7:55. doi: 10.4103/2152-7806.181906. eCollection 2016.
BACKGROUND:There are few reported cases of an epidural spinal hematoma following interventional pain procedures. CASE DESCRIPTION: We report a case of a spinal epidural hematoma in a patient with no known risk factors (e.g. coagulopathy), who underwent an epidural steroid injection (ESI) in the same anatomic location as two previously successful ESI procedures. CONCLUSION: Early detection was the key to our case, and avoiding sedation allowed the patient to recognize the onset of a new neurological deficit, and lead to prompt diagnosis as well as surgical decompression of the resultant hematoma.
KEYWORDS:Epidural hematoma; epidural steroid injection; increased risk of neurological deficit; no long-term efficacy; paraparesis

Hematoma espinal subaracnoideo secundario a anestesia espinal. Reporte de un caso
Dr. Oscar Eduardo Martínez-Baeza,* Dra. Claudia Agustina Ramos-Olmos,** Dr. Arnulfo Durá
Revista Mexicana de Anestesiología Volumen 38, No. 2, abril-junio 2015

Bloqueo epidural, hematoma peridural y enoxaparina
Dr. Elio Cordero-Escobar, Dr. Carlos Segovia-García, Dr. Victor Whizar-Lugo, Dr. Josué Torres-Chávez, Carlos Villareal-Rubio 
Anestesia en México Volumen 16 Número 3 Julio - Septiembre 2004

Guía de práctica clínica para el manejo de la anestesia regional en el paciente que recibe anticoagulación y tromboprofilaxis
Revista Mexicana de Anestesiología  Vol. 35. Supl. 2 Julio-Septiembre 2012 pp S390-S424
5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.

Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

Informes  (477) 716 06 16,
4° Congreso Internacional de Control Total de la Vía Aérea
Asociación Mexicana de Vía  Aérea Difícil, AC
Ciudad de México 21, 22 y 23 de Abril 2017
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