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regional anesthesia and anticoagulants

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https://www.readbyqxmd.com/read/28727314/transperitoneal-rectus-sheath-block-and-transversus-abdominis-plane-block-for-laparoscopic-inguinal-hernia-repair-a-novel-approach
#1
Jun Nagata, Jun Watanabe, Masato Nagata, Yusuke Sawatsubashi, Masaki Akiyama, Takehide Tajima, Koichi Arase, Noritaka Minagawa, Takayuki Torigoe, Yoshifumi Nakayama, Reiko Horishita, Kentaro Kida, Kotaro Hamada, Keiji Hirata
INTRODUCTION: A laparoscopic approach for inguinal hernia repair is now considered the gold standard. Laparoscopic surgery is associated with a significant reduction in postoperative pain. Epidural analgesia cannot be used in patients with perioperative anticoagulant therapy because of complications such as epidural hematoma. As such, regional anesthetic techniques, such as ultrasound-guided rectus sheath block and transversus abdominis plane block, have become increasingly popular. However, even these anesthetic techniques have potential complications, such as rectus sheath hematoma, if vessels are damaged...
August 2017: Asian Journal of Endoscopic Surgery
https://www.readbyqxmd.com/read/28628578/neuraxial-anesthesia-in-obstetric-patients-receiving-thromboprophylaxis-with-unfractionated-or-low-molecular-weight-heparin-a-systematic-review-of-spinal-epidural-hematoma
#2
Lisa R Leffert, Heloise M Dubois, Alexander J Butwick, Brendan Carvalho, Timothy T Houle, Ruth Landau
Venous thromboembolism remains a major source of morbidity and mortality in obstetrics with an incidence of 29.8/100,000 vaginal delivery hospitalizations; cesarean delivery confers a 4-fold increased risk of thromboembolism when compared with vaginal delivery. Revised national guidelines now stipulate that the majority of women delivering via cesarean and women at risk for ante- or postpartum venous thromboembolism receive mechanical or pharmacological thromboprophylaxis. This practice change has important implications for obstetric anesthesiologists concerned about the risk of spinal epidural hematoma (SEH) among anticoagulated women receiving neuraxial anesthesia...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28526159/anticoagulation-and-neuraxial-peripheral-anesthesia
#3
REVIEW
Mudit Kaushal, Ryan E Rubin, Alan D Kaye, Karina Gritsenko
Novel anticoagulants (NAGs) have emerged as the preferred alternatives to vitamin K antagonists. In patients being considered for regional anesthesia, these drugs present a layer of complexity in the preprocedure evaluation. There are no established tests to monitor anticoagulant activity and our experience is short with these drugs. These authors believe it is important to review the relevant hematology, orthopedics, and anesthesiology literature to provide a valuable reference for the clinician who is met with these challenges...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28526151/novel-anticoagulant-agents-in-the-perioperative-setting
#4
REVIEW
Allyson Lemay, Alan D Kaye, Richard D Urman
An increasing number of oral anticoagulants have become available over the past decade. Each of these agents has differing implications on both regional and neuraxial anesthetic techniques. This article describes the pharmacology, pharmacokinetics, and pharmacodynamics of the most commonly used novel oral anticoagulants (NOACs). It also outlines recent guidelines for the use of NOACs in the perioperative setting, especially with regard to neuraxial anesthesia.
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28492441/residual-enoxaparin-activity-anti-xa-levels-and-concerns-about-the-american-society-of-regional-anesthesia-and-pain-medicine-anticoagulation-guidelines
#5
Daryl S Henshaw, James D Turner, Daniel J Forest, Garrett R Thompson, Robert S Weller
Currently, the American Society of Regional Anesthesia and Pain Medicine (ASRA) anticoagulation guidelines recommend that before the performance of a neuraxial procedure a minimum of 24 hours should elapse following a treatment dose of enoxaparin (1 mg/kg twice daily or 1.5 mg/kg once daily). The guidelines have since their inception also consistently recommended against the routine use of anti-Xa level monitoring for patients receiving enoxaparin. However, we noted in our clinical practice that anti-Xa levels were frequently still elevated despite patients meeting the time-based recommendation for treatment dose enoxaparin...
July 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28360531/a-review-and-survey-of-policies-utilized-for-interventional-pain-procedures-a-need-for-consensus
#6
Lynn Kohan, Reza Salajegheh, Robin J Hamill-Ruth, Sandeep Yerra, John Butz
BACKGROUND: Other than the newly published anticoagulation guidelines, there are currently few recommendations to assist pain medicine physicians in determining the safety parameters to follow when performing interventional pain procedures. Little information exists regarding policies for oral intake, cumulative steroid dose limits, driving restrictions with and without sedation, and routine medication use for interventional procedures. METHODS: A 16-question survey was developed on common policies currently in use for interventional pain procedures...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28339551/anticoagulant-and-antiplatelet-management-for-spinal-procedures-a-prospective-descriptive-study-and-interpretation-of-guidelines
#7
Bradly S Goodman, L McLean House, Sridhar Vallabhaneni, Srinivas Mallempati, Matthew R Willey, Matthew Thomas Smith
Setting.:  Epidural hematoma rarely complicates interventional spine procedures. While anticoagulant and antiplatelet drugs increase bleeding risk, cessation may precipitate serious thromboembolic events. The Spine Intervention Society (SIS) and American Society of Regional Anesthesia and Pain Medicine (ASRA) put forth guidelines that dissent with regard to management of hemostatically active agents during commonly performed spinal injections. Objective.:  To validate an antiplatelet/anticoagulant management table based on modifications of the SIS 2013 and ASRA 2015 guidelines...
October 6, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28255948/what-adverse-events-and-injuries-are-cited-in-anesthesia-malpractice-claims-for-nonspine-orthopaedic-surgery
#8
Christopher D Kent, Linda S Stephens, Karen L Posner, Karen B Domino
BACKGROUND: Malpractice claims that arise during the perioperative care of patients receiving orthopaedic procedures will frequently involve both orthopaedic surgeons and anesthesiologists. The Anesthesia Closed Claims database contains anesthesia malpractice claim data that can be used to investigate patient safety events arising during the care of orthopaedic patients and can provide insight into the medicolegal liability shared by the two specialties. QUESTIONS/PURPOSES: (1) How do orthopaedic anesthetic malpractice claims differ from other anesthesia claims with regard to patient and case characteristics, common events and injuries, and liability profile? (2) What are the characteristics of patients who had neuraxial hematomas after spinal and epidural anesthesia for orthopaedic procedures? (3) What are the characteristics of patients who had orthopaedic anesthesia malpractice claims for central ischemic neurologic injury occurring during shoulder surgery in the beach chair position? (4) What are the characteristics of patients who had malpractice claims for respiratory depression and respiratory arrests in the postoperative period? METHODS: The Anesthesia Closed Claims Project database was the source of data for this study...
March 2, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27982554/regional-anaesthesia-and-antithrombotic-agents-instructions-for-use
#9
Gennaro Scibelli, Lucia Maio, Gennaro Savoia
BACKGROUND: The use of anticoagulant agents represents a serious limitation of regional anesthesia, due to the risk of spinal hematoma. Examining all the principles currently available, it has been possible to notice that published guidelines are very often incomplete or also differ significantly on the rules to be followed relating to a specific drug. METHODS: We have carried out a comparison between the guidelines of major scientific societies in order to take a practical and simple user guide which operators can consult...
March 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27900415/-management-of-anesthesia-in-endovascular-interventions
#10
REVIEW
T Rössel, R Paul, T Richter, S Ludwig, T Hofmockel, A R Heller, T Koch
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach...
December 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27687455/risk-stratification-perioperative-and-periprocedural-management-of-the-patient-receiving-anticoagulant-therapy
#11
REVIEW
Adriana D Oprea, Christopher J Noto, Thomas M Halaszynski
As a result of the aging US population and the subsequent increase in the prevalence of coronary disease and atrial fibrillation, therapeutic use of anticoagulants has increased. Perioperative and periprocedural management of anticoagulated patients has become routine for anesthesiologists, who frequently mediate communication between the prescribing physician and the surgeon and assess the risks of both thromboembolic complications and hemorrhage. Data from randomized clinical trials on perioperative management of antithrombotic therapy are lacking...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27536909/paraplegia-after-thoracic-epidural-steroid-injection
#12
Vivek Loomba, Hirsh Kaveeshvar, Samvid Dwivedi
Epidural steroid injections are a common procedure performed by pain physicians. The American Society of Regional Anesthesia along with several other groups recently provided guidelines for performing epidural injections in the setting of anticoagulants. We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case...
September 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27290980/use-of-direct-oral-anticoagulants-with-regional-anesthesia-in-orthopedic-patients
#13
REVIEW
Gianluca Cappelleri, Andrea Fanelli
The use of direct oral anticoagulants including apixaban, rivaroxaban, and dabigatran, which are approved for several therapeutic indications, can simplify perioperative and postoperative management of anticoagulation. Utilization of regional neuraxial anesthesia in patients receiving anticoagulants carries a relatively small risk of hematoma, the serious complications of which must be acknowledged. Given the extensive use of regional anesthesia in surgery and the increasing number of patients receiving direct oral anticoagulants, it is crucial to understand the current clinical data on the risk of hemorrhagic complications in this setting, particularly for anesthesiologists...
August 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27076369/initial-experience-of-the-american-society-of-regional-anesthesia-and-pain-medicine-coags-regional-smartphone-application-a-novel-report-of-global-distribution-and-clinical-usage-of-an-electronic-decision-support-tool-to-enhance-guideline-use
#14
Rajnish K Gupta, Matthew D McEvoy
BACKGROUND AND OBJECTIVES: Decision support tools have been demonstrated to improve adherence to medical guidelines; however, smartphone applications (apps) have not been studied in this regard. In a collaboration between Vanderbilt University and the American Society of Regional Anesthesia and Pain Medicine (ASRA), the ASRA Coags Regional app was created to be a decision support tool for the 2010 published guideline on regional anesthesia for patients receiving anticoagulation. This is a review of the distribution and usage of this app...
May 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/26995947/-placenta-percreta-a-severe-obstetric-complication-despite-correct-diagnosis-a-case-report
#15
Karolina Gruca-Stryjak, Mariola Ropacka-Lesiak, Grzegorz Breborowicz
This paper presents a case of a pregnant woman with a history of two cesarean sections. The patient was admitted to the hospital because of vaginal bleeding. The ultrasound revealed a placenta covering the internal os. The placenta was characterized by heterogeneous echogenicity with visible irregular hypoechogenic areas and blurred border between the placenta and the cervix. Rich vascularity was observed on the border of the placenta, urethra and the urinary bladder. Cystoscopy showed severe congestion around the urethra...
December 2015: Ginekologia Polska
https://www.readbyqxmd.com/read/26952228/effectiveness-of-combined-regional-general-anesthesia-for-reducing-mortality-in-coronary-artery-bypass-meta-analysis
#16
REVIEW
Fabiano Timbó Barbosa, Rafael Martins da Cunha, Fernando Wagner da Silva Ramos, Fernando José Camello de Lima, Amanda Karine Barros Rodrigues, Ailton Mota do Nascimento Galvão, Célio Fernando de Sousa-Rodrigues, Paula Monique Barbosa Lima
BACKGROUND AND OBJECTIVES: Neuraxial anesthesia (NA) has been used in association with general anesthesia (GA) for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS: Mortality, arrhythmias, cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stay (LHS), length of ICU stay (ICUS), reoperations, blood transfusion (BT), quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed...
March 2016: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/26882272/periprocedural-management-of-direct-oral-anticoagulants-comment-on-the-2015-american-society-of-regional-anesthesia-and-pain-medicine-guidelines
#17
REVIEW
James D Douketis, Summer Syed, Sam Schulman
No abstract text is available yet for this article.
March 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/26800356/risk-of-hemorrhage-during-needle-based-ophthalmic-regional-anesthesia-in-patients-taking-antithrombotics-a-systematic-review
#18
REVIEW
Augusto Takaschima, Patricia Marchioro, Thiago M Sakae, André L Porporatti, Luis André Mezzomo, Graziela De Luca Canto
BACKGROUND: Patients undergoing ophthalmic surgery are usually elderly and, due to systemic disease, may be on long-term therapy, such as antithrombotic agents. Rates of hemorrhagic complications associated with invasive procedures may be increased by the use of anticoagulants and antiplatelet agents. OBJECTIVE: To compare the incidence of hemorrhagic complications in patients undergoing needle-based ophthalmic regional anesthesia between patients on antithrombotic therapy and those not on such therapy...
2016: PloS One
https://www.readbyqxmd.com/read/26553953/the-effect-of-anesthesia-type-on-major-lower-extremity-amputation-in-functionally-impaired-elderly-patients
#19
COMPARATIVE STUDY
Carla C Moreira, Alik Farber, Jeffrey A Kalish, Mohammad H Eslami, Sebastian Didato, Denis Rybin, Ghoerghe Doros, Jeffrey J Siracuse
OBJECTIVE: Patients undergoing major lower extremity amputations are at risk for a wide variety of perioperative complications. Elderly patients with any functional impairment have been shown to be at high risk for these adverse events. Our goal was to determine the association between the type of anesthesia-general anesthesia (GA) and regional/spinal anesthesia (RA)-on perioperative outcomes after lower extremity amputation in these elderly and functionally impaired patients. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data set (2005-2012) was queried to identify all patients aged ≥75 years with partial or total functional impairment who underwent major lower extremity amputations...
March 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/26347411/neuraxial-and-peripheral-nerve-blocks-in-patients-taking-anticoagulant-or-thromboprophylactic-drugs-challenges-and-solutions
#20
REVIEW
Jinlei Li, Thomas Halaszynski
Incidence of hemorrhagic complications from neuraxial blockade is unknown, but classically cited as 1 in 150,000 epidurals and 1 in 220,000 spinals. However, recent literature and epidemiologic data suggest that for certain patient populations the frequency is higher (1 in 3,000). Due to safety concerns of bleeding risk, guidelines and recommendations have been designed to reduce patient morbidity/mortality during regional anesthesia. Data from evidence-based reviews, clinical series and case reports, collaborative experience of experts, and pharmacology used in developing consensus statements are unable to address all patient comorbidities and are not able to guarantee specific outcomes...
2015: Local and Regional Anesthesia
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