epidura/spinal in patients on plavix/anticoaguation with complete quadriplegia?

[anbuitachi]

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Is there any reason to hold plavix in these scenarios, lets say for a lumbar epidural? they are already completely quadriplegic. even if get epidural hematoma... what will change?

 

[dabears505]

Does having a large hematoma sitting around increase chance of infection development? Could there be substantial blood loss?

 

[anbuitachi]

Does having a large hematoma sitting around increase chance of infection development? Could there be substantial blood loss?

not that im aware of. i think when we dont put in epdiurals on plavix , its bc of neurological dmg due to hematoma. not the massive blood loss and infection risk

 

[deleted162650]

Back in residency I asked essentially this same question to one of our senior staff. Super brilliant guy, ex-department chair, authored the neuro-anesthesia chapters in the big textbooks.

He looked at me and said “If a tree falls in the woods . . . “

 

[CodeBlu]

Why risk it? ASRA says no... I go with ASRA ftw!

 

[CavGas]

Never had a similar case, but out of curiosity.. Does somebody with complete sensory loss need anesthesia or will some sedation be enough?

 

[deleted87051]

Never had a similar case, but out of curiosity.. Does somebody with complete sensory loss need anesthesia or will some sedation be enough?

Depending on procedure, they may need anesthesia to prevent/inhibit autonomic hyperreflexia.

 

[coffeebythelake]

Never had a similar case, but out of curiosity.. Does somebody with complete sensory loss need anesthesia or will some sedation be enough?

AUTONOMIC DYSREFLEXIA

 

[Hoya11]

Depending on procedure, they may need anesthesia to prevent/inhibit autonomic hyperreflexia.

yes but why in the world would you choose neuraxial in this patient to accomplish that? just do an LMA or even ppfl with face mask and give some fentanyl .. odd question, curious what the case was..

 

[coffeebythelake]

yes but why in the world would you choose neuraxial in this patient to accomplish that? just do an LMA or even ppfl with face mask and give some fentanyl .. odd question, curious what the case was..

Yes I imagine some very unique set of circumstances, or maybe just some mental masyurbation

 

[Iso4ane]

Back in residency I asked essentially this same question to one of our senior staff. Super brilliant guy, ex-department chair, authored the neuro-anesthesia chapters in the big textbooks.

He looked at me and said “If a tree falls in the woods . . . “

So is that saying he would do it, cause there would be no appreciable change I’m even if a hematoma occurred?

 

[GassYous]

So is that saying he would do it, cause there would be no appreciable change I’m even if a hematoma occurred?

Like the other guy was saying, it can be a nydus for infection but I don't think that there should be any other probems. Mass effect on already paralyzed limbs? Does it matter?

 

[vector2]

Intrathecal hemorrhage is also a complication of neuraxial. Now, it's unlikely that it would bleed enough intrathecally to cause much harm, but assuming the risks of unnecessarily putting blood into someone's subarachnoid space when there's a perfectly safe alternative seems a bit questionable.

 

[deleted697535]

yes but why in the world would you choose neuraxial in this patient to accomplish that? just do an LMA or even ppfl with face mask and give some fentanyl .. odd question, curious what the case was..

For any of the reasons that you would chose to do a spinal anyway.
What if ADR risk plus horrific AW, severe pulm HTN etc etc whatever

There are guidelines on what to do if significant ADR risk that addresses these questions...
BJA wrote one about 5 years back. If lesion below T6 very unlikely to have ADR etc

 

[lobelsteve]

More info please: Why lumbar epidural needed?