Epidurals for Free-Flap Grafts: Optimizing Graft Survival and Preventing Complications in the Anticoagulated Patient

Abstract

OPEN ACCESSMay 10, 2013Epidurals for Free-Flap Grafts: Optimizing Graft Survival and Preventing Complications in the Anticoagulated Patient Kirk Lalwani, MD, Kate Maureen Ropp, MD Kirk Lalwani, MD Oregon Health & Science University School of Medicine Google Scholar More articles by this author , Kate Maureen Ropp, MD Oregon Health & Science University School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9415 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: This narrative problem-based learning module is designed to facilitate group discussion with the integration of clinical knowledge and self-directed learning. It addresses a complex situation involving trauma, neuraxial anesthesia, anticoagulation, free-flap physiology, and compartment syndrome in a setting of multiple treatment teams. Methods: After a case presentation, the instructor guides the group through a series of questions, each of which promotes discussion and reviews the available data on the subject. The module provides multiple diagnostic and decision points in which learners must balance the risk versus benefit of available options, and choose a management strategy on the basis of existing and new knowledge of current practice. The module was created based on the authors' personal experience with a similar situation and a subsequent literature search on the issues covered in the module. Selected significant references and current national guidelines were added to the bibliography to enhance the learner experience and highlight current evidence to support the management options presented in the discussion. Results: This module was developed for use at the 2004 and 2006 American Society of Anesthesiologists Annual Scientific Meetings and was presented twice to learners (residents, anesthesiology faculty in academic practices, and private practice anesthesiologists) at each meeting. It was also utilized with pediatric anesthesiology fellows at the primary author's institution. In all, the module has been used in a small-group roundtable format six times, with positive feedback from conference attendees and pediatric anesthesiology fellows. Discussion: The module can easily be incorporated into a residency, fellowship, or CME curriculum. It has the potential to be implemented as a single 2-hour team exercise, or be divided into two 1-hour sessions depending on time available. Educational Objectives By the end of this module, learners will be able to: Discuss the effects of anesthetic drugs and epidural anesthesia on free-flap graft survival.Compare the risks and benefits of epidural anesthesia for management of trauma patients who require anticoagulation.Describe the recognition and treatment of compartment syndrome in trauma patients following epidural anesthesia.Interpret and practice the latest American Society of Regional Anesthesia guidelines regarding neuraxial anesthesia and anticoagulation. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx References.docx Stem Case with Model Discussion.docx Stem Case.docx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2013 Lalwani and Ropp. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsCompartment SyndromesAnesthesiaAnticoagulationTraumaFree Flap SurgeryWounds and Injuries Disclosures None to report. Funding/Support None to report. Prior Presentations Management of Latissimus Dorsi Free-Flap for Lower Limb Salvage Following Traumatic Bilateral Near-Amputation: Does an Epidural Really Help? Problem-based learning discussion at: American Society of Anesthesiology Annual Scientific Meeting; 2004; Las Vegas, Nevada. Epidurals for Free-Flap Grafts; Optimizing Graft Survival and Preventing Complications in the Anticoagulated Patient. Problem-based learning discussion at: American Society of Anesthesiology Annual Scientific Meeting; 2006; Chicago, Illinois. Loading ...