scholarly journals Aspirin and spinal haematoma after neuraxial anaesthesia: Myth or reality?

2015 ◽  
Vol 115 (5) ◽  
pp. 688-698 ◽  
Author(s):  
R.S. Vela Vásquez ◽  
R. Peláez Romero
Keyword(s):  
Spinal Haematoma ◽  
Neuraxial Anaesthesia

scholarly journals Subdural intracranial and spinal haematoma secondary to neuraxial anaesthesia

2018 ◽  
Vol 33 (7) ◽  
pp. 476-477
Author(s):  
M.A. Figueroa Arenas ◽  
L.Y. Castañeda Rodríguez ◽  
J.C. Pérez Redondo ◽  
D.F. Uría
Keyword(s):  
Spinal Haematoma ◽  
Neuraxial Anaesthesia

scholarly journals Invited Commentary: Neuraxial Anaesthesia for Appendectomy: Another Tool in the Toolbox

2021 ◽  
Vol 45 (11) ◽  
pp. 3302-3303
Author(s):  
Folke Hammarqvist ◽  
Mark Schumacher
Keyword(s):  
Neuraxial Anaesthesia

scholarly journals Association between neuraxial anaesthesia or general anaesthesia for lower limb revascularisation surgery in adults and clinical outcomes: population based comparative effectiveness study

BMJ ◽  
2020 ◽  
pp. m4104
Author(s):  
Derek J Roberts ◽  
Sudhir K Nagpal ◽  
Dalibor Kubelik ◽  
Timothy Brandys ◽  
Henry T Stelfox ◽  
...  
Keyword(s):  
Hospital Stay ◽  
General Anaesthesia ◽  
Lower Limb ◽  
Odds Ratio ◽  
Instrumental Variable ◽  
Length Of Hospital Stay ◽  
Population Based ◽  
Neuraxial Anaesthesia ◽  
Renal Complications ◽  
Comparative Effectiveness Study

Abstract Objective To examine the associations between neuraxial anaesthesia or general anaesthesia and clinical outcomes, length of hospital stay, and readmission in adults undergoing lower limb revascularisation surgery. Design Comparative effectiveness study using linked, validated, population based databases. Setting Ontario, Canada, 1 April 2002 to 31 March 2015. Participants 20 988 patients Ontario residents aged 18 years or older who underwent their first lower limb revascularisation surgery in hospitals performing 50 or more of these surgeries annually. Main outcome measures Primary outcome was 30 day all cause mortality. Secondary outcomes were in-hospital cardiopulmonary and renal complications, length of hospital stay, and 30 day readmissions. Multivariable, mixed effects regression models, adjusting for patient, procedural, and hospital characteristics, were used to estimate associations between anaesthetic technique and outcomes. Robustness of analyses were evaluated by conducting instrumental variable, propensity score matched, and survival sensitivity analyses. Results Of 20 988 patients who underwent lower limb revascularisation surgery, 6453 (30.7%) received neuraxial anaesthesia and 14 535 (69.3%) received general anaesthesia. The percentage of neuraxial anaesthesia use ranged from 0.6% to 90.6% across included hospitals. Furthermore, use of neuraxial anaesthesia declined by 17% over the study period. Death within 30 days occurred in 204 (3.2%) patients who received neuraxial anaesthesia and 646 (4.4%) patients who received general anaesthesia. After multivariable, multilevel adjustment, use of neuraxial anaesthesia compared with use of general anaesthesia was associated with decreased 30 day mortality (absolute risk reduction 0.72%, 95% confidence interval 0.65% to 0.79%; odds ratio 0.68, 95% confidence interval 0.57 to 0.83; number needed to treat to prevent one death=139). A similar direction and magnitude of association was found in instrumental variable, propensity score matched, and survival analyses. Use of neuraxial anaesthesia compared with use of general anaesthesia was also associated with decreased in-hospital cardiopulmonary and renal complications (odds ratio 0.73, 0.63 to 0.85) and a reduced length of hospital stay (−0.5 days, −0.3 to−0.6 days). Conclusions Use of neuraxial anaesthesia compared with general anaesthesia for lower limb revascularisation surgery was associated with decreased 30 day mortality and hospital length of stay. These findings might have been related to reduced cardiopulmonary and renal complications after neuraxial anaesthesia and support the increased use of neuraxial anaesthesia in patients undergoing these surgeries until the results of a large, confirmatory randomised trial become available.

Historic timeline of obstetric anaesthesia

2016 ◽  
Author(s):  
Alistair G. McKenzie
Keyword(s):  
Rapid Sequence Induction ◽  
Late Pregnancy ◽  
Spinal Block ◽  
Major Advance ◽  
Acid Aspiration ◽  
Obstetric Anaesthesia ◽  
Neuraxial Anaesthesia ◽  
Caudal Analgesia ◽  
The 1960S ◽  
Acid Aspiration Syndrome

Foremost in the history of obstetric anaesthesia was the introduction of inhalational analgesia by James Simpson in 1847, first with ether and then chloroform. Nitrous oxide was first used in obstetrics in 1880. Neuraxial anaesthesia in obstetrics began with spinal block by Oskar Kreis in 1900, and within 25 years included pudendal, caudal, and paracervical blocks. From 1902 there was a vogue for ‘twilight sleep’, which remained in use until the 1950s. Spinal anaesthesia only became popular with the advent of procaine in 1905; favour declined in the United Kingdom from 1948 and did not return until 40 years later. In 1930, Aburel described the pain pathways of labour. Continuous caudal analgesia for labour was popularized from 1942; it was superseded by the lumbar epidural approach in the 1960s. The arrival of lidocaine in 1950 was a major advance. Another important event in the 1960s was the elucidation of the supine hypotensive syndrome of late pregnancy. In the 1940s, intravenous barbiturates became popular. Mendelson published on the acid aspiration syndrome in 1946. It took 40 years to establish a reliable system of prevention, including fasting, antacids, and rapid sequence induction. This developed piecemeal, aided by recommendations from the British Confidential Enquiries into Maternal Deaths reports beginning in 1957. Neuraxial anaesthesia advanced: 24-hour epidural services (1960s), bupivacaine (1970s), epidural opioids (1980s), use of low-concentration bupivacaine with fentanyl mixtures, patient-controlled epidural and combined spinal–epidural analgesia (1990s), and pencil-point spinal needles (1990s). From the 1980s obstetric anaesthetists have assumed key roles in management of labour, preeclampsia/eclampsia, major haemorrhage, and perioperative care.

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