Incidence Of Epidural Hematoma Research Articles

Primary Results of Our Protocol for Standardization of Perioperative Antiplatelet Agent Management on the Incidence of Epidural Hematoma and Thrombotic Complications in Posterior Cervical Surgery: A Prospective Cohort Study

Primary Results of Our Protocol for Standardization of Perioperative Antiplatelet Agent Management on the Incidence of Epidural Hematoma and Thrombotic Complications in Posterior Cervical Surgery: A Prospective Cohort Study

Revisiting Anticoagulation in Spine Surgery: Balancing Venous Thromboembolic Events and Epidural Hematoma.

Retrospective Cohort Study. Venous thromboembolic events (VTE) and post-operative epidural hematoma (EDH) are significant complications after spine surgery. Guidelines for chemoprophylaxis are controversial and variability amongst surgeons remains. The objective of this study was to establish the incidence of clinical VTE and EDH at our institution and evaluate the association of chemoprophylaxis with clinical VTE and EDH. We conducted a retrospective cohort study of patients undergoing spine surgery at a high-volume tertiary care center in Seattle, WA between January 2016 and December 2019. The Premier Health Care Database and Agency for Healthcare Research and Quality (AHRQ) patient indicators PSI-9 (Perioperative hemorrhage and hematoma) and PSI-12(Perioperative PE or DVT) were used to identify patients experiencing VTE and/or post-operative EDH. The primary outcome was the incidence of clinical VTE and EDH in post-operative spine patients. Secondary outcomes included the association of chemoprophylaxis with clinical VTE and EDH. From 2016 to 2019, 4587 patients underwent spine surgery, totaling 4764 hospital stays. The incidence of clinical VTE was .21% (10/4764) and the incidence of EDH was .10% (5/4764). Most hemorrhages occurred prior to the initiation of chemoprophylaxis. One patient with EDH received chemoprophylaxis prior to hemorrhage. The rate of post-operative clinical VTE and EDH in spine surgery is low. Despite early initiation of chemoprophylaxis after major spine surgery we did not appreciate a high rate of EDH. We attribute our low rate of clinical VTE to multimodal prophylaxis with SCDs, early mobilization and chemoprophylaxis on post-operative day 1.

Controlled Decompression Attenuates Brain Injury in a Novel Rabbit Model of Acute Intracranial Hypertension.

BackgroundIn the past, standard rapid decompressive craniectomy was used to alleviate the secondary damage caused by high intracranial pressure. Recent clinical studies showed that controlled decompression may have a better curative effect than rapid decompression. However, the effect on controlled decompression in animals is unclear.Material/MethodsTotally 80 healthy male New Zealand rabbits were randomly divided into a sham group (n=20), a rapid decompression group (n=30), and a controlled decompression group (n=30). An intracranial hypertension model was induced by injecting saline into an epidural balloon catheter and reducing ICP slowly and gradually by use of a pressure pump. The model was evaluated and analyzed by general observations, imaging examination, ICP values, behavioral score, brain water content, Nissl staining, and caspase-3 protein detection.ResultsThe mortality rate was 36.7% (11/30) in the rapid group, 20% (6/30) in the controlled group, and 5% (1/20) in the sham group. The incidence of epidural hematoma in the controlled group was lower than in the rapid group (p<0.01). The ICP was significantly lower in the controlled group than in the rapid group (p<0.001), and the behavioral score in the rapid group was higher than in the controlled group (p<0.05). There was a marked difference in brain water content between the controlled group and the rapid group (p<0.01). Nissl staining demonstrated that the ratio of Nissl body in the controlled group was significantly higher than in the rapid group (p<0.01). WB detection showed the expression of Caspase-3 in the controlled group was lower than in the rapid group (p<0.05).ConclusionsThe results show the advantages of use of controlled decompression with intracranial hypertension. The animal model we developed provides a platform for further research on controlled decompression.

Thoracic epidural analgesia in donor hepatectomy: An analysis.

The purpose of this study is to analyze whether supplementation of general anesthesia (GA) with thoracic epidural analgesia (TEA) for right lobe donor hepatectomy is a safe modality of pain relief in terms of changes in postoperative coagulation profile, incidence of epidural catheter-related complications, and timing of removal of epidural catheter. Retrospective analysis of the record of 104 patients who received TEA for right lobe donor hepatectomy was done. Platelet count, international normalized ratio, alanine aminotransferase, and aspartate aminotransferase were recorded postoperatively until the removal of the epidural catheter. The day of removal of the epidural catheter and visual analogue scale (VAS) scores were also recorded. Any complication encountered was documented. Intraoperatively, central venous pressure (CVP), hemodynamic variables, and volume of intravenous fluids infused were also noted. Statistical analysis was performed by using SPSS statistical package, version 17.0 (SPSS Inc. Chicago, IL). Continuous variables were presented as mean ± standard deviation. A total of 90% of patients had mean VAS scores between 1 and 4 in the postoperative period between days 1 and 5. None of the patients had a VAS score above 5. Although changes in coagulation status were encountered in all patients in the postoperative period, these changes were transient and did not persist beyond postoperative day (POD) 5. There was no delay in removal of the epidural catheter, and the majority of patients had the catheter removed by POD 4. There was no incidence of epidural hematoma. Aside from good intraoperative and postoperative analgesia, TEA in combination with balanced GA and fluid restriction enabled maintenance of low CVP and prevention of hepatic congestion. In conclusion, vigilant use of TEA appears to be safe during donor hepatectomy. Living liver donors should not be denied efficient analgesia for the fear of complications. Liver Transplantation 24 214-221 2018 AASLD.

New progress of pain management after total knee arthroplasty

Background The postoperative pain after total knee arthroplasty(TKA) is the main reason to affect the early postoperative function exercise of the knees. Postoperative analgesia is a challenging task for medical personnel because it requires not only good analgesia effect, but also a minimal impact on joint movement function. The regional anesthesia techniques provides a good direction for the management of postoperative pain. Objective To introduce the advantages and risks of various regional pain management after TKA and review the new research advances to provide new clues for pain management after TKA. Content Femoral nerve block(FNB) provides effective postoperative analgesia for patients recovering from TKA. Whether using the sciatic nerve block additionally as the clinical treatment method or not is still in disputation. Lumbar epidural block can obviously increase the incidence of epidural hematoma in orthopedic patients. Femoral nerve block can provide a similar effect and greater satisfaction. In the meantime, comparing with the epidural pain management, it also can obviously reduce the risk of adverse reactions occurrence. Local infiltration analgesi(LIA) and adductor canal block have hope to get enough pain control and with fewer side effects. Trend LIA management and adductor canal block may replace FNB as pain management after TKA, but it still need further clinical trials to verify current results. Key words: Total knee arthroplasty; Analgesia; Regional analgesia

Contrecoup Acute Epidural Hematoma—A Rare Case Report

AbstractEpidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the dural membrane. Contact-related skull deformation causes inbending or fracturing of cranium or both, leading to separation of the dura mater from inner table. This injures the dural arteries, veins, venous sinus, or diploid channels, producing EDH. They usually occur as a result of direct impact injuries to the head, ipsilateral to impact side. Incidence of epidural hematoma is 1 to 3% of all head injuries. Contrecoup EDH cases are rare. and because of its rarity, we present a case report of a 17-year-old boy with contrecoup EDH who sustained head injury due to road traffic accident. Computed tomography of the brain showed left occipital bone fracture and large contrecoup extradural hematoma in right frontal region associated with pneumocephalus and hemorrhagic contusional edema beneath it. The EDH was operated on, and the patient was discharged uneventfully.

Bleeding Complications in Patients Undergoing Percutaneous Spinal Cord Stimulator Trials and Implantations.

Spinal cord stimulators (SCS) are indicated for the management of multiple pain states with strong evidence. Recent guidelines recommend discontinuing aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) for the described procedures. The goal of this investigation is to assess the rate of bleeding and neurologic sequelae in patients undergoing SCS trials and implantation. This is a retrospective review from 2005 through 2014 of all patients 18 years or older undergoing the following procedures: Percutaneous SCS implantations, SCS revisions, and SCS trials. Baseline characteristics, antiplatelet and anticoagulation medications, coagulation parameters, and procedural details were extracted. The primary outcome was the presence of a bleeding complication within 31 days of the procedure requiring emergency medicine, neurology, or neurosurgical evaluation. The neurological complication was independently categorized for its potential relationship to procedural bleeding, and periprocedural red blood cell transfusion requirements were analyzed as a secondary outcome. A total of 642 percutaneous SCS procedures were performed on 421 unique patients, including 346 SCS trials, 255 SCS implantations, and 41 revision surgeries. Patients had received aspirin or NSAIDs within 7 days of needle placement for 101 procedures (15.7%). There were no bleeding or neurological complications identified in this cohort. Although the incidence of epidural hematoma is low, the development of bleeding complications following SCS lead placement can be devastating. In the present investigation, we identified no cases of epidural hematoma following percutaneous SCS lead placement, including more than 100 patients receiving aspirin or NSAIDs. Future investigations with larger numbers are needed to better define the relationships between periprocedural aspirin and NSAID utilization and bleeding complications.

Retrospective Analysis of the Incidence of Epidural Haematoma in Patients With Epidural Catheters and Abnormal Coagulation Parameters

Background Epidural haematoma is a rare but potentially catastrophic complication associated with epidural catheterization. The times of insertion and removal of epidural catheters are high-risk periods for epidural haematoma formation, especially with abnormal coagulation parameters. There is a lack of data on the incidence of epidural haematoma in patients with abnormal coagulation parameters. Methods A retrospective analysis was undertaken from 2002 to 2009 on patients with an epidural catheter. Queries were performed on the coagulation parameters for the dates of placement and removal of the catheters and on all documented epidural haematoma cases. Results During the study period, 11 600 epidural catheters were placed. In the setting of abnormal coagulation parameters, 278 (2.4%) epidural catheters were placed and 351 (3%) were removed. Two epidural haematomas occurred; both patients had epidural catheters and spinal drains placed for vascular procedures with abnormal coagulation parameters after operatation. The haematomas occurred after removal of the catheters. Based on our study, the incidence of epidural haematoma in patients with abnormal coagulation parameters is 1 in 315 patients, with the lower limit of the 95% confidence interval at 87 and the upper limit at 2597. Conclusions The risk of epidural haematoma is clearly elevated with abnormal coagulation parameters. Our data suggest that as the incidence of epidural haematoma with neuraxial access in patients with abnormal coagulation is not 100%, individual risk–benefit evaluations are warranted.

Retrospective analysis of the incidence of epidural haematoma in patients with epidural catheters and abnormal coagulation parameters

Epidural haematoma is a rare but potentially catastrophic complication associated with epidural catheterization. The times of insertion and removal of epidural catheters are high-risk periods for epidural haematoma formation, especially with abnormal coagulation parameters. There is a lack of data on the incidence of epidural haematoma in patients with abnormal coagulation parameters. A retrospective analysis was undertaken from 2002 to 2009 on patients with an epidural catheter. Queries were performed on the coagulation parameters for the dates of placement and removal of the catheters and on all documented epidural haematoma cases. During the study period, 11 600 epidural catheters were placed. In the setting of abnormal coagulation parameters, 278 (2.4%) epidural catheters were placed and 351 (3%) were removed. Two epidural haematomas occurred; both patients had epidural catheters and spinal drains placed for vascular procedures with abnormal coagulation parameters after operatation. The haematomas occurred after removal of the catheters. Based on our study, the incidence of epidural haematoma in patients with abnormal coagulation parameters is 1 in 315 patients, with the lower limit of the 95% confidence interval at 87 and the upper limit at 2597. The risk of epidural haematoma is clearly elevated with abnormal coagulation parameters. Our data suggest that as the incidence of epidural haematoma with neuraxial access in patients with abnormal coagulation is not 100%, individual risk-benefit evaluations are warranted.

Epidural analgesia reduces perioperative myocardial infarction and all-cause mortality after cardiac surgery: but at least 25 epidural hematomas have already happened

Epidural analgesia on top of general anesthesia in cardiac surgery might improve relevant clinical outcomes but the incidence of epidural hematoma is under-reported.

Extent of Decompression and Incidence of Postoperative Epidural Hematoma Among Different Techniques of Spinal Decompression in Degenerative Lumbar Spinal Stenosis

Prospective radiographic cohort study. To study the extent of bony decompression and dural sac expansion after laminectomy (including subtotal laminectomy and laminotomy with midline resection), bilateral fenestration, and unilateral fenestration with contralateral undercutting in lumbar spinal canal stenosis. Further, to investigate differences of incidence and extent of early postoperative epidural hematoma in these approaches. There are different techniques of decompression in lumbar spinal stenosis. An overall good clinical outcome has been reported with different biomechanical consequences, but no morphometric comparative reports exist on these approaches. Using the data of a previous prospective study of 30 patients, who underwent lumbar decompression for degenerative stenosis, 49 levels treated with 3 different kinds of surgical approaches were analyzed: (1) laminectomy (including subtotal laminectomy, laminotomy with midline resection); (2) bilateral fenestration; and (3) unilateral fenestration with contralateral undercutting. In all 3 groups, the cross-sectional area of the maximum bony stenosis and dural sac compression (bony margins and dural sac expansion) were measured in each operated level before and after the operation. Occurrence of epidural hematoma and its size were noted in the 3 groups. Median postoperative bony stenosis was not significantly different in the groups, being 330 mm(2), 333.5 mm(2), and 261.5 mm(2), respectively, in groups 1, 2, and 3. There was no statistically significant difference between the median postoperative extension of dural sac areas in the 3 groups, measuring 125 mm(2), 123 mm(2), and 137 mm(2). The incidence of epidural hematoma was similar in the 3 groups. Levels where postoperative epidural hematoma was detected had larger bony decompression independent of the surgical approach compared with the whole group. Unilateral and bilateral approaches achieve a similar amount of dural sac extension by a lesser extent of bony resection in comparison with the laminectomy approach. There is a tendency of increased postoperative hematoma in approaches with greater bony decompression area.

Thoracic Epidural Analgesia and Acute Pain Management

AIN continues to be a significant problem for many patients after major surgery. In addition to improving patient satisfaction and decreasing pain scores, enhanced perioperative pain control can improve clinical outcomes. Thoracic epidural analgesia (TEA) remains a critical tool for anesthesiologists to use in acute pain management. TEA is particularly effective for reducing pain after thoracic and upper abdominal surgery and likely permits major surgical procedures to be performed on patients with moderate to severe comorbid diseases, who several years ago may have been determined to be too great a risk for surgery. In the past 10 yr, peripheral nerve blockade has improved perioperative analgesia for patients undergoing extremity surgery. Although nerve blocks have reduced the use of continuous lumbar epidural analgesia, anesthesiologists must understand the indications, placement techniques, solutions administered, potential complications, and evidence-based outcomes for TEA in acute pain management. Indications

Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital

Helmet use has been associated with fewer hospital visits among injured skiers and snowboarders, but there remains no evidence that helmets alter the intracranial injury patterns. The authors hypothesized that helmet use among skiers and snowboarders reduces the incidence of head injury as defined by findings on head CT scans. The authors performed a retrospective review of head-injured skiers and snowboarders at 2 Level I trauma centers in New England over a 6-year period. The primary outcome of interest was intracranial injury evident on CT scans. Secondary outcomes included the following: need for a neurosurgical procedure, presence of spine injury, need for ICU admission, length of stay, discharge location, and death. Of the 57 children identified who sustained a head injury while skiing or snowboarding, 33.3% were wearing a helmet at the time of injury. Of the helmeted patients, 5.3% sustained a calvarial fracture compared with 36.8% of the unhelmeted patients (p = 0.009). Although there was a favorable trend, there was no significant difference in the incidence of epidural hematoma, subdural hematoma, intraparenchymal hemorrhage, subarachnoid hemorrhage, or contusion in helmeted and unhelmeted patients. With regard to secondary outcomes, there were no significant differences between the 2 groups in percentage of patients requiring neurosurgical intervention, percentage requiring admission to an ICU, total length of stay, or percentage discharged home. There was no difference in the incidence of cervical spine injury. There was 1 death in an unhelmeted patient, and there were no deaths among helmeted patients. Among hospitalized children who sustained a head injury while skiing or snowboarding, a significantly lower number of patients suffered a skull fracture if they were wearing helmets at the time of the injury.

Method of epidural space suffusion liquid reflow prevent epidural anesthesia toxic reflection and increase the effectivity of epidural anesthesia

Objective To explore the feasibility of liquid reflow test in epidural space to prevent toxic reaction of local anesthetics and to improve success rate of epidural blocking. Methods 2 000 patients undergone epidural anesthesia were enrolled. All patients were on left recumbent position, punctured by normal beam testing And the epidural tube were left 3cm deep in epidural space. Draw 3ml saline with syringe, and connected it into the end of the tube. ResultS of liquid reflow test were classified as: yes or no.The character of reflow liquid were tobserved for 5 minutes ( -clear, +week red, ++obviously red, +++deep red, ++++redness). The characters of liquid reflow, anesthesia effect and complications were continuously observed during the surgery.Results The reflow liquid has a relative effect with anesthesia performance. One patient's reflow liquid was found to be blood and were stopped injecting the drug into epidural space, so the possible toxic reaction were avoided. All patients had no nerve or spinal cord complications. One patient's reflow liquid was blood at the end of surgery. Conclusion Method of epidural space liquid reflow prevents anesthesia toxic reflection, increases the effectivity of epidural anesthesia and timely monitors the incidence of epidural hematoma. Key words: Epidural space; Liquid, reflow; Toxic reflection, local drug; Monitor

Epidural Hematoma After Neuraxial Blockade

We conducted a detailed 54-year retrospective review of patients who developed epidural hematoma after neuraxial blockade in a university hospital and throughout Mainland China. Incidence, risk factors, and outcomes in the Chinese population were identified. The incidence of epidural hematoma after neuraxial blockade was 2.14 of 100,000 (95% confidence interval: 0.44-6.25 of 100,000). Patients who had a bacterial infection and required emergency surgery were at increased risk of developing epidural hematoma. There is a significant correlation between good neurologic recovery and short interval to decompressive surgery.

Postoperative spinal epidural hematoma resulting in cauda equina syndrome: a case report and review of the literature

Spinal epidural hematoma is a well known complication of spinal surgery. Clinically insignificant small epidural hematomas develop in most spinal surgeries following laminectomy. However, the incidence of clinically significant postoperative spinal epidural hematomas that result in neurological deficits is extremely rare. In this report, we present a 33-year-old female patient whose spinal surgery resulted in postoperative spinal epidural hematoma. She was diagnosed with lumbar disc disease and underwent hemipartial lumbar laminectomy and discectomy. After twelve hours postoperation, her neurologic status deteriorated and cauda equina syndrome with acute spinal epidural hematoma was identified. She was immediately treated with surgical decompression and evacuation of the hematoma. The incidence of epidural hematoma after spinal surgery is rare, but very serious complication. Spinal epidural hematomas can cause significant spinal cord and cauda equina compression, requiring surgical intervention. Once diagnosed, the patient should immediately undergo emergency surgical exploration and evacuation of the hematoma.

Think about Room Air

Eastern Maine Medical Center, Bangor, Maine. edsalldw@aol.comI read the articles “Post–Dural Puncture Bacterial Meningitis”1and “Incidence of Epidural Hematoma, Infection, Neurologic Injury in Obstetric Patients with Epidural Analgesia/Anesthesia”2and the editorial “Gloved and Masked—Will Gowns Be Next? The Role of Asepsis during Neuraxial Instrumentation”3in the August 2006 issue of Anesthesiology. They are very informative with many excellent areas of discussion. However, it seems to me that there is one glaringly large area that was missed in all three articles. The issue is the source of contamination of the epidural space. It makes me shudder to see anesthesiologists inject room air, which may have a droplet from any of a dozen people's noses who have been in the room in the past hour! Many residents, not sure of the feel, will then inject several more milliliters. Then they wonder why they have a spotty block! But that is another issue. In my opinion, injecting air should have been clearly condemned, but it was not even mentioned. Three of the four deaths presented had multiple epidural attempts, at least some with inexperienced personnel. How many cubic centimeters of air were injected? Maybe the source of infection results from the combination of air plus a dural puncture. Was there an epidural attempt before the obstetric spinal case? The only thing that should be injected into the epidural space is sterile liquid that is filtered for glass. Preferring the feel of the air is not enough reason to use air for the loss-of-resistance technique. Are there any other reasons that are backed up with data for using air? Rather than go through the inconvenience of learning the feel of the saline method, those practitioners continue to subject the patient to the risk of infection. This ban should include the hanging drop method. Although less air is entrailed, why allow any? It seems clear that the data show that room air has contaminated droplets and that injecting them into the epidural space is unnecessary and of greater risk than using saline. Of even more concern is how many other issues are out there, easily discovered, if we only followed up with our patients and accurately measured outcomes as we are morally obligated to, but rarely, do.Eastern Maine Medical Center, Bangor, Maine. edsalldw@aol.com

Incidence of Epidural Hematoma, Infection, and Neurological Injury in Obstetric Patients With Epidural Analgesia/Anesthesia

Survey of Anesthesiology: April 2007 - Volume 51 - Issue 2 - p 95 doi: 10.1097/01.sa.0000258183.03326.95

Incidence of Epidural Hematoma, Infection, and Neurologic Injury in Obstetric Patients with Epidural Analgesia/Anesthesia

Incidence of Epidural Hematoma, Infection, and Neurologic Injury in Obstetric Patients with Epidural Analgesia/Anesthesia

Can Epidural Anesthesia and Warfarin be Coadministered?

Epidural hypotensive anesthesia can, in addition to imparting numerous intraoperative benefits, provide excellent postoperative pain control for patients having joint arthroplasties. However, because of the risk of epidural hematoma, epidural anesthesia is not coadministered with anticoagulation in some centers. We retrospectively ascertained, by chart review, the incidence of epidural hematoma in 11,235 patients having 12,991 knee arthroplasties at our institution who received oral anticoagulation and epidural anesthesia for their surgery. Warfarin was administered on the day of surgery. With the exception of 212 patients, the epidural catheter was removed within 48 hours of surgery. Based on clinical examinations, we detected no epidural hematomas. For 1030 patients (1038 knees) whose charts were reviewed in detail, the mean international normalized ratio at the time of removal of the epidural catheter was 1.54 (range, 0.93-4.25). We identified no other complications related to the coadministration of epidural anesthesia and warfarin. Although administration of epidural anesthesia in patients with coagulopathy can be detrimental, we recognized no cases of epidural hematoma causing neurologic symptoms in patients receiving controlled oral anticoagulation after total knee arthroplasty.