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. Singhal N1, Sethi P2, Jain JK3, Agarwal S3. 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 PDF 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. Estcourt LJ1, Ingram C, Doree C, Trivella M, Stanworth SJ. Cochrane Database Syst Rev. 2016 May 24;(5):CD011980. doi: 10.1002/14651858.CD011980.pub2. Abstract 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. PDF 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. Iwashita K1, Shigematsu K1, Higa K1, Nitahara K1. Case Rep Anesthesiol. 2014;2014:291728. doi: 10.1155/2014/291728. Epub 2014 May 5. Abstract 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. PDF 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 PDF 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. Siasios ID1, Vakharia K1, Gibbons KJ1, Dimopoulos VG1. Surg Neurol Int. 2016 Sep 22;7(Suppl 25):S664-S667. eCollection 2016. Abstract 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 HTML  Hematoma epidural después de inyección epidural de esteroides Epidural hematoma after routine epidural steroid injection. Alkhudari AM1, Malk CS1, Rahman A1, Penmetcha T1, Torres M1. Surg Neurol Int. 2016 May 6;7:55. doi: 10.4103/2152-7806.181906. eCollection 2016. Abstract 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 HTML 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 PDF 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 HTML 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 PDF 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, kikinhedz@gmail.com 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 Informes: amvadmexico@gmail.com

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Inestabilidad patelar del adolescente: revisión de los conceptos actuales

http://www.artroscopiayreemplazos.com.mx/academia/inestabilidad-patelar-del-adolescente-revision-de-los-conceptos-actuales/

Adolescent patellar instability: current concepts review

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28148656

http://www.bjj.boneandjoint.org.uk/content/99-B/2/159.long

De:

Clark D1,Metcalfe A2,Wogan C3,Mandalia V4,Eldridge J3.

Bone Joint J.

2017 Feb;99-B(2):159-170. doi: 10.1302/0301-620X.99B2.BJJ-2016-0256.R1.

Todos los derechos reservados para:

©2017 The British Editorial Society of Bone & Joint Surgery.

Abstract

Patellar instability most frequently presents during adolescence. Congenital and infantile dislocation of the patella is a distinct entity from adolescent instability and measurable abnormalities may be present at birth. In the normal patellofemoral joint an increase in quadriceps angle and patellar height are matched by an increase in trochlear depth as the joint matures. Adolescent instability may herald a lifelong condition leading to chronic disability and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction in the young adult prevents further instability. Although these techniques are proven in the young adult, they may cause growth arrest and deformity where the physis is open. A vigorous non-operative strategy may permit delay of surgery until growth is complete. Where non-operative treatment has failed a modified MPFL reconstruction may be performed to maintain stability until physeal closure permits anatomical reconstruction. If significant growth remains an extraosseous reconstruction of the MPFL may impart the lowest risk to the physis. If minor growth remains image intensifier guided placement of femoral intraosseous fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to adolescent instability and provides a framework for management of these patients. Cite this article: Bone Joint J 2017;99-B:159-70.

©2017 The British Editorial Society of Bone & Joint Surgery.

KEYWORDS:

Adolescent; Dislocation; Instability; Paediatric; Patella; Patellofemoral

Resumen

La inestabilidad rotuliana se presenta con mayor frecuencia durante la adolescencia. La dislocación congénita e infantil de la rótula es una entidad distinta de la inestabilidad del adolescente y anormalidades mensurables pueden estar presentes al nacer. En la articulación patelofemoral normal un aumento en el ángulo del cuádriceps y en la altura de la rótula se corresponde con un aumento en la profundidad troclear a medida que la articulación madura. La inestabilidad del adolescente puede anunciar una condición de toda la vida que conduce a la discapacidad crónica y la artritis. La restauración de la anatomía normal mediante trocleoplastia, la transferencia del tubérculo tibial o la reconstrucción del ligamento patelofemoral mediano (MPFL) en el adulto joven impide una mayor inestabilidad. Aunque estas técnicas se prueban en el adulto joven, pueden causar la detención del crecimiento y la deformidad donde la physis está abierta. Una estrategia no operativa vigorosa puede permitir el retraso de la cirugía hasta que el crecimiento esté completo. Cuando el tratamiento no operativo ha fracasado, se puede realizar una reconstrucción de MPFL modificada para mantener la estabilidad hasta que el cierre fisico permita la reconstrucción anatómica. Si sigue habiendo un crecimiento significativo una reconstrucción extraósea del MPFL puede impartir el riesgo más bajo a la physis. Si el crecimiento menor permanece intensificador de la imagen, la colocación guiada de la fijación intraósea femoral puede impartir un pequeño, pero aceptable, riesgo para la physis. Este artículo presenta y discute la literatura relacionada con la inestabilidad de los adolescentes y proporciona un marco para el manejo de estos pacientes. Citar este artículo: Bone Joint J 2017; 99-B: 159-70.

© 2017 Sociedad Editorial Británica de Cirugía de Huesos y Articulaciones.

PALABRAS CLAVE:
Adolescente; Dislocación; Inestabilidad; Pediátrico; Rótula; Patelofemoral

PMID: 28148656  DOI:  

10.1302/0301-620X.99B2.BJJ-2016-0256.R1

[PubMed – indexed for MEDLINE]

#adolescente#dislocación#inestabilidad#rótula#patelofemoral

Variación de la inclinación pélvica funcional en pacientes sometidos a artroplastia total de cadera

http://www.traumaysiniestros.com.mx/academia/variacion-de-la-inclinacion-pelvica-funcional-en-pacientes-sometidos-a-artroplastia-total-de-cadera/

Variation in functional pelvic tilt in patients undergoing total hip arthroplasty

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28148659

http://www.bjj.boneandjoint.org.uk/content/99-B/2/184?platform=hootsuite

De:

Pierrepont J1,Hawdon G2,Miles BP3,Connor BO3,Baré J4,Walter LR5,

Marel E5,Solomon M6,McMahon S7,Shimmin AJ8.

Bone Joint J. 2017 Feb;99-B(2):184-191. doi: 10.1302/0301-620X.99B2.BJJ-2016-0098.R1.

Todos los derechos reservados para:

©2017 The British Editorial Society of Bone & Joint Surgery.

Abstract

AIMS:

The pelvis rotates in the sagittal plane during daily activities. These rotations have a direct effect on the functional orientation of the acetabulum. The aim of this study was to quantify changes in pelvic tilt between different functional positions.

CONCLUSION:

Planning and measurement of the intended position of the acetabular component in the supine position may fail to predict clinically significant changes in its orientation during functional activities, as a consequence of individual pelvic kinematics. Optimal orientation is patient-specific and requires an evaluation of functional pelvic tilt pre-operatively. Cite this article: Bone Joint J 2017;99-B:184-91.

©2017 The British Editorial Society of Bone & Joint Surgery.

KEYWORDS:

Component orientation; Dislocation; Implant positioning; Pelvic tilt

Resumen

OBJETIVOS:
La pelvis gira en el plano sagital durante las actividades diarias. Estas rotaciones tienen un efecto directo en la orientación funcional del acetábulo. El objetivo de este estudio fue cuantificar los cambios en la inclinación pélvica entre diferentes posiciones funcionales.

CONCLUSIÓN:
La planificación y medición de la posición deseada del componente acetabular en posición supina puede no predecir cambios clínicamente significativos en su orientación durante las actividades funcionales, como consecuencia de la cinemática pélvica individual. La orientación óptima es específica del paciente y requiere una evaluación de la inclinación pélvica funcional antes de la operación. Citar este artículo: Bone Joint J 2017; 99-B: 184-91.

© 2017 Sociedad Editorial Británica de Cirugía de Huesos y Articulaciones.

PALABRAS CLAVE:
Orientación de los componentes; Dislocación; Posicionamiento del implante; Inclinación pélvica

PMID: 28148659   DOI:  

10.1302/0301-620X.99B2.BJJ-2016-0098.R1

[PubMed – indexed for MEDLINE]

#Orientación de los componentes#dislocación#Posicionamiento del implante#implante#Inclinación pélvica#pelvis