Chapter Pain Medicine (asra) Guidelines: Neuraxial Anesthesia – Flashcards
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Why are epidural bleeds more common?
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Prominent epidural venous plexus
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How does spinal hematoma present?
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Progression of sensory and motor block, bowel and bladder dysfunction
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When is spinal ischemia reversible and how?
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Laminectomy within 8 hours with 38% with partial or complete recovery
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When should heparin be given relative to epidural placement and removal?
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Placement 1 hour before heparin Removal 2-4 hours after last heparin dose
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How long should neurologic symptoms be monitored after an epidural is removed?
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12 hours
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What are the recommendations for subcutaneous heparin frequency for patients with epidurals?
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2x/d is OK but 3x/d is not recommended
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What are risk factors for spinal hematoma on LMWH?
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Female Advance age Renal insufficiency Spinal stenosis Ankylosing spondylitis Traumatic placement Indwelling epidural catheter Epidural-spinal Concurrent antiplatelet
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True or false; anti-Xa monitoring on LMWH is recommended for neuraxial anesthesia.
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False. Not predictive of bleeding
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What is a high dose of LMWH and how long should you wait before needle placement?
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24 hours
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How long before spinal should LMWH be dosed?
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>2hours
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When should LMWH be given postoperatively?
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24h for twice daily dosing 6-8 h for once daily dosing
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What are the times to reduction in coag factors regarding warfarin?
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Factor VII at 6 hours Factor II at 50-80 hours Factor X at 25-60 hours
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What should INR be for epidural to be removed?
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1.5
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What INR should warfarin be reduced if indwelling catheter is present?
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3
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What should be done for INR 1.5 to 3.0 and epidural removal?
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Neuro checks
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Time interval for discontinuation of ticlopidine and neuraxial blockade?
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14 days
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Time interval for discontinuation of clopidogrel and neuraxial blockade?
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7 days
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How long for neuraxial with glycoprotein IIb/IIIa inhibitors like abciximab?
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24-48 hours
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How long for neuraxial with glycoprotein IIb/IIIa inhibitors like eptifibatide and tirofiban?
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4-8 hours
