Lumbar neuraxial procedures in thrombocytopenic patients across populations: A systematic review and meta-analysis

Bauer, Melissa E.; Toledano, Roulhac D.; Houle, Timothy T.; Beilin, Yaakov; MacEachern, Mark; McCabe, Madeline; Rector, Dana; Cooper, Joyce; Gernsheimer, Terry; Landau, Ruth; Leffert, Lisa

doi:10.1016/j.jclinane.2019.109666

Cited by 32 publications

(21 citation statements)

References 22 publications

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“…It is therefore advisable to rule out thrombocytopenia before attempting neuraxial techniques in a COVID-19-positive or suspected patient. A platelet count of 75,000 9 10 6 .l À1 or above has been suggested as an acceptable level for performing of neuraxial procedures in the obstetric population, provided the platelet function is expected to be normal [56]. The use of neuraxial procedures during pregnancy and delivery was reported in early studies from China.…”

Section: Recommendationmentioning

confidence: 99%

Neuraxial anaesthesia and peripheral nerve blocks during the COVID‐19 pandemic: a literature review and practice recommendations

et al. 2020

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Summary Coronavirus disease 2019 (COVID‐19) has had a significant impact on global healthcare services. In an attempt to limit the spread of infection and to preserve healthcare resources, one commonly used strategy has been to postpone elective surgery, whilst maintaining the provision of anaesthetic care for urgent and emergency surgery. General anaesthesia with airway intervention leads to aerosol generation, which increases the risk of COVID‐19 contamination in operating rooms and significantly exposes the healthcare teams to COVID‐19 infection during both tracheal intubation and extubation. Therefore, the provision of regional anaesthesia may be key during this pandemic, as it may reduce the need for general anaesthesia and the associated risk from aerosol‐generating procedures. However, guidelines on the safe performance of regional anaesthesia in light of the COVID‐19 pandemic are limited. The goal of this review is to provide up‐to‐date, evidence‐based recommendations or expert opinion when evidence is limited, for performing regional anaesthesia procedures in patients with suspected or confirmed COVID‐19 infection. These recommendations focus on seven specific domains including: planning of resources and staffing; modifying the clinical environment; preparing equipment, supplies and drugs; selecting appropriate personal protective equipment; providing adequate oxygen therapy; assessing for and safely performing regional anaesthesia procedures; and monitoring during the conduct of anaesthesia and post‐anaesthetic care. Implicit in these recommendations is preserving patient safety whilst protecting healthcare providers from possible exposure.

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Section: Recommendationmentioning

confidence: 99%

Neuraxial anaesthesia and peripheral nerve blocks during the COVID‐19 pandemic: a literature review and practice recommendations

et al. 2020

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“…In these cases, multidisciplinary teams are recommended, and antifibrinolytics and/or hormonotherapy could be prescribed [ 27 ]. An important challenge is the preparation for delivery in which recently published guidelines recommend PC above 70 × 10 9 /L for neuraxial procedures (provided that platelet function is preserved) [ 28 ].…”

Section: Pathogenesis Diagnosis and General Management Of Itmentioning

confidence: 99%

Role of Thrombopoietin Receptor Agonists in Inherited Thrombocytopenia

Bastida

González‐Porras

Rivera

et al. 2021

IJMS

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In the last decade, improvements in genetic testing have revolutionized the molecular diagnosis of inherited thrombocytopenias (ITs), increasing the spectrum of knowledge of these rare, complex and heterogeneous disorders. In contrast, the therapeutic management of ITs has not evolved in the same way. Platelet transfusions have been the gold standard treatment for a long time. Thrombopoietin receptor agonists (TPO-RA) were approved for immune thrombocytopenia (ITP) ten years ago and there is evidence for the use of TPO-RA not only in other forms of ITP, but also in ITs. We have reviewed in the literature the existing evidence on the role of TPO-RAs in ITs from 2010 to February 2021. A total of 24 articles have been included, 4 clinical trials, 3 case series and 17 case reports. A total of 126 patients with ITs have received TPO-RA. The main diagnoses were Wiskott–Aldrich syndrome, MYH9-related disorder and ANKRD26-related thrombocytopenia. Most patients were enrolled in clinical trials and were treated for short periods of time with TPO-RA as bridging therapies towards surgical interventions, or other specific approaches, such as hematopoietic stem cell transplantation. Here, we have carried out an updated and comprehensive review about the efficacy and safety of TPO-RA in ITs.

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“…The smallest travel distance (about 0.4 m) occurs with the use of a Hudson mask utilizing 4 l/min of O 2 flow. With a nasal cannula and 5 l/min, the particles can travel about 1 m [ 14 ]. Therefore the flow of oxygen should be kept to a minimum with a purpose to maintain saturation and minimize aerosol generation.…”

Section: Patient Management During Administration and Management Of Regional Anesthesiamentioning

confidence: 99%

Regional anesthesia in coronavirus disease 2019 pandemic

Heijnen

Vandebergh

Vandepitte

et al. 2021

Current Opinion in Anaesthesiology

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Purpose of review Coronavirus disease 19 (COVID-19) has presented numerous challenges to healthcare systems worldwide. The virus is highly contagious and infectious since transmission can occur via multiple routes. General measures to prevent viral transmission to patients and healthcare personnel, such as a reduction in clinical load and routine testing, must be coupled with multiple additional safety measures in perioperative services. Recent findings Regional anesthesia preserves respiratory function and reduces aerosol-generating procedures typically associated with airway management in general anesthesia, making it the first choice for a suspected or confirmed COVID-19 patient in need of surgery with anesthesia. A well thought out regional anesthetic plan, implementation of hygiene and (personal) safety measures are necessary to ensure the best possible outcome for both the patient and the healthcare staff. Summary The present review addresses both practical and recommended measures for performing regional anesthesia in the pandemic, to ensure patient and staff safety, and equipment protection. Further research and evidence-based guidelines are necessary to devise an established standard of care during the current COVID-19 and possible future pandemics.

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Lumbar neuraxial procedures in thrombocytopenic patients across populations: A systematic review and meta-analysis

Cited by 32 publications

References 22 publications

Neuraxial anaesthesia and peripheral nerve blocks during the COVID‐19 pandemic: a literature review and practice recommendations

Neuraxial anaesthesia and peripheral nerve blocks during the COVID‐19 pandemic: a literature review and practice recommendations

Role of Thrombopoietin Receptor Agonists in Inherited Thrombocytopenia

Regional anesthesia in coronavirus disease 2019 pandemic

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