Kontinuierliche lumbale Epiduralanästhesie

Bernhardt, A.; Bald, Carlos; Helfrich, U; Haubelt, Hannelore

doi:10.1007/s00101-008-1371-5

Cited by 7 publications

(1 citation statement)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are case reports in the literature notifying the occurrence of an epidural hematoma following a lumbar puncture in patients who were not known to have hemophilia (Bernhardt et al, 2008;Faillace et al, 1989). The use of a regional block in patients with bleeding disorders is controversial because of the risk of developing hematoma which leads to epidural or spinal bleeding and a permanent neurological damage.…”

Section: Hemophilia a And Hemophilia Bmentioning

confidence: 99%

Epidural Analgesia - Current Views and Approaches

Fyneface-Ogan¹

2012

View full text Add to dashboard Cite

users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source.As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. NoticeStatements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book.

show abstract

Section: Hemophilia a And Hemophilia Bmentioning

confidence: 99%

Epidural Analgesia - Current Views and Approaches

Fyneface-Ogan¹

2012

View full text Add to dashboard Cite

show abstract

Rückenmarknahe Regionalanästhesie bei Patienten mit hämorrhagischen Diathesen

2011

View full text Add to dashboard Cite

Neuraxial anesthesia is an established and safe procedure in perioperative pain therapy which can help to minimize complications and to improve perioperative outcome. In patients with acquired bleeding disorders by comorbidities or concomitant antithrombotic medication an individual decision should be made based on risks and benefits. A large number of literature references and guidelines help making a decision, for example the recently updated evidence-based guidelines of the American Society of Regional Anesthesia and Pain Medicine for patients receiving antithrombotic or thrombolytic therapy. However, no explicit recommendations or guidelines exist for patients with hemorrhagic diatheses, such as von Willebrand disease (vWD), hemophilia A and B and idiopathic thrombocytopenic purpura (ITP). Published data regarding the safety of neuraxial techniques in these patients is scarce. Neuraxial anesthesia in patients with vWD is only acceptable when coagulation is optimized (substitution of factor concentrates or hemostatic agents depending on the type of vWD) and monitored frequently during the procedure. The only exception might be obstetric patients with vWD type I as coagulation frequently normalizes at the end of pregnancy. In these patients neuraxial anesthesia can often be performed without supplementation of clotting factors.Neuraxial techniques in patients with hemophilia A or B are usually contraindicated. The procedure may only be acceptable if serious reasons exist against general anesthesia. Supplementation of the missing factor to normal levels and monitoring during procedure is essential if neuraxial block is performed.Patients with ITP often present with low platelet counts. Normally, spinal or epidural anesthesia is considered safe if the platelet count is over 80,000/µl. However, the consistently low platelet counts in ITP seem to be less problematic than rapidly falling values due to other diseases, because this is often accompanied by platelet dysfunction or coagulopathy. In several studies neuraxial anesthesia was successfully performed with platelet counts between 50,000 and 80,000/µl. Nevertheless, the minimum safe platelet count for neuraxial blockade remains undefined in these patients.Evidence-based recommendations for neuraxial anaesthesia in patients with hemophilia, vWD or ITP cannot be offered. Each patient has to be treated individually with appropriate caution. This overview is intended to assist in the decision for or against neuraxial anesthesia in these patients, with emphasis on the pathophysiological background, blood investigations and case reports from the literature.

show abstract