Slightly elevated ptt (43), normal platelet

[Laurel123]

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normal inr and no signs or symptoms of bleeding. Takes ultram - would you do a spinal?

 

[dhb]

you can ask for a corrected ptt ( added pooled plasma) if still abnormal --> lupus anti-coagulant which is prothrombotic i'd do a spinal if ptt corrected then is a factor deficiency / von willebrand and i wouldn't do a spinal

 

[militarymd]

from purely a medical standpoint, I would....

but in the real world...."you go to sleep now"

 

[Planktonmd]

normal inr and no signs or symptoms of bleeding. Takes ultram - would you do a spinal?

No

 

[Noyac]

It depends on the case but I would probably do it if warranted.

 

[Noyac]

No

No, thats it?

Cesarean?

Bad airway for knee scope?

TURP in a very poor candidate of GA, severe COPD, etc?

Or is it just flat NO?

 

[Planktonmd]

No, thats it?

Cesarean?

Bad airway for knee scope?

TURP in a very poor candidate of GA, severe COPD, etc?

Or is it just flat NO?

Nothing is written in stone but here is how I see it:
If there is a confirmed antiphospholipid syndrome then it's OK otherwise you have to give me a really good reason to expose myself to lawyers in the unlikely event that something happens.
Cesarean with anticipated difficult intubation could be.
The knee scope with bad airway can get a fem-sciatic block.
The TURP who is a bad candidate for GA is probably a bad candidate for a TURP as well.

 

[militarymd]

Has anyone EVER PERSONALLY seen an epidural hematoma FROM:

- a spinal
- epidural
- lumbar puncture
- myelogram
- or other procedures where we stick a needle in someone's back.

 

[kraphtymac]

Yes. But it was in a 65 y/o trauma patient (heme variables unknown)... no hematoma prior to LP, but massive thereafter...

 

[militarymd]

Yes. But it was in a 65 y/o trauma patient (heme variables unknown)... no hematoma prior to LP, but massive thereafter...

tell us a little more about the HPI like:

type of injury...ISS score or other trauma scoring system used
meds taken
meds given..
etc....

and most importantly....why a LP in a trauma patient???

 

[Noyac]

Has anyone EVER PERSONALLY seen an epidural hematoma FROM:

- a spinal
- epidural
- lumbar puncture
- myelogram
- or other procedures where we stick a needle in someone's back.

Not me.

There was a report of a hematoma from an epidural at our neighboring hospital last year but I never saw it. Thats as close as I can remember to seeing one.

 

[Planktonmd]

Has anyone EVER PERSONALLY seen an epidural hematoma FROM:

- a spinal
- epidural
- lumbar puncture
- myelogram
- or other procedures where we stick a needle in someone's back.

I have!
Pain doctor does steroid epidural injection, patient comes to us with epidural hematoma and gets laminectmy.
Patient was taking NSAIDS but no other anticoagulants and no known coagulation abnormality.

 

[militarymd]

I have!
Pain doctor does steroid epidural injection, patient comes to us with epidural hematoma and gets laminectmy.
Patient was taking NSAIDS but no other anticoagulants and no known coagulation abnormality.

anymore hx?

what was injected?

other meds?

age?

 

[Planktonmd]

anymore hx?

what was injected?

other meds?

age?

Patient around 50 Y/O.
Don't remember rest of the story, it was 3 years ago.

 

[pd4emergence]

I saw one as a resident in a healthy pregnant (30 plus week) patient. It was a transfer from an outside hospital. LP was performed in the ER at this hospital for some reason that I can't remember. Pt admitted and later started having back pain then weakness and bladder issues. MRI at the OSH with epidural hematoma. Pt was then transferred to us (1.5 hours away). By the time we got her it had been at least 6 hours since she had started having symptoms and they were progressing. OB's sectioned her before the decompression (they only drained about 4cc of blood out of the epidural space). It was a nightmare and one of those cases you never forget. Baby ended up ok but mom has significant deficits. By the way this patient had normal coags and normal platelets. Heme saw her post op and could find no reason.
So a patient with an unexplained PTT of 43? I would not do a spinal unless I had a really good reason for the patient to need a spinal. If it was an elective case and she could not have a general because of an airway issue, I would cancel and send her to see a hematologist.

 

[militarymd]

I saw one as a resident in a healthy pregnant (30 plus week) patient. It was a transfer from an outside hospital. LP was performed in the ER at this hospital for some reason that I can't remember. Pt admitted and later started having back pain then weakness and bladder issues. MRI at the OSH with epidural hematoma. Pt was then transferred to us (1.5 hours away). By the time we got her it had been at least 6 hours since she had started having symptoms and they were progressing. OB's sectioned her before the decompression (they only drained about 4cc of blood out of the epidural space). It was a nightmare and one of those cases you never forget. Baby ended up ok but mom has significant deficits. By the way this patient had normal coags and normal platelets. Heme saw her post op and could find no reason.
So a patient with an unexplained PTT of 43? I would not do a spinal unless I had a really good reason for the patient to need a spinal. If it was an elective case and she could not have a general because of an airway issue, I would cancel and send her to see a hematologist.

why would a healthy person need a LP?

And why would 4cc of blood (we put 20 in a blood patch) cause probelms?

 

[Laurel123]

Has anyone EVER PERSONALLY seen an epidural hematoma FROM:

- a spinal
- epidural
- lumbar puncture
- myelogram
- or other procedures where we stick a needle in someone's back.

No. And I just think back as an intern in the ER and ICU rotations. We would LP all kinds of people without getting coags, and a lot of these people were sick and septic or having renal or liver disease. And used to LP them with those big 22 gauge cutting needles too! But I don't remember any complications - or at least I don't remember anyone being very concerned about hematomas.

 

[Laurel123]

normal inr and no signs or symptoms of bleeding. Takes ultram - would you do a spinal?

Though this wasn't my case, I found out more details. Does this change anything?

Morbidly obese 50 year old for Total knee. Had two kids 20 years ago with epidurals and a hysterectomy few years ago without any issues. No history of bleeding, no bruising. Platelets normal, H/H normal, INR = 1.

 

[pd4emergence]

why would a healthy person need a LP?

And why would 4cc of blood (we put 20 in a blood patch) cause probelms?

I think she had a real bad headache and nausea, maybe fever, I don't remember. I do remember it was a pretty soft reason for doing an LP. The 4 cc thing did not make much sense to me either that is why I mentioned it. But that is how much the brain surgeons told me they took out. I said "was it in the dura?", they said no way all epidural. This was the topic of endless discussions later and nobody came up with a good answer. Her neurologic function did improve after the operation but never fully recovered.

 

[jwk]

Though this wasn't my case, I found out more details. Does this change anything?

Morbidly obese 50 year old for Total knee. Had two kids 20 years ago with epidurals and a hysterectomy few years ago without any issues. No history of bleeding, no bruising. Platelets normal, H/H normal, INR = 1.

I guess my question would be why any coag studies were drawn in the first place. They're not routine for us or our surgeons, and I doubt anyone would raise an eyebrow with an epidural or SAB.

 

[Planktonmd]

Though this wasn't my case, I found out more details. Does this change anything?

Morbidly obese 50 year old for Total knee. Had two kids 20 years ago with epidurals and a hysterectomy few years ago without any issues. No history of bleeding, no bruising. Platelets normal, H/H normal, INR = 1.

No.
INR and PTT represent 2 different coagulation pathways.
This woman still has an abnormal PTT value and no solid indication to say that the benefit of the spinal outweighs the risk.

 

[Jeff05]

something is up with this pt's intrinsic pathway, however, i would not cancel this case for a heme w/u, as it would not change the management. inhibitors - give FFP. lupus AC - do nothing (if no h/o thrombosis). can get heme w/u postop if elevated ptt persists (after pt off LMWH prophylaxis, of course).

therefore, FFP x2.
proceed with CSE.

or not.

tube, lots of postop pain.

 

[toughlife]

Though this wasn't my case, I found out more details. Does this change anything?

Morbidly obese 50 year old for Total knee. Had two kids 20 years ago with epidurals and a hysterectomy few years ago without any issues. No history of bleeding, no bruising. Platelets normal, H/H normal, INR = 1.

I'd do a femoral nerve block for post op pain and "you go to sleep now"

 

[VentdependenT]

something is up with this pt's intrinsic pathway, however, i would not cancel this case for a heme w/u, as it would not change the management. inhibitors - give FFP. lupus AC - do nothing (if no h/o thrombosis). can get heme w/u postop if elevated ptt persists (after pt off LMWH prophylaxis, of course).

therefore, FFP x2.
proceed with CSE.

or not.

tube, lots of postop pain.

So you are going to expose this guy to potential risks of blood product transfusion just so you can do a CSE? Not a chance dude. Not a chance.

Repeat PTT if you'd like. May just be lab error.

Me, I'm not waiting. Proseal LMA, asleep femoral nerve block. PCA post op. See ya.

 

[Jeff05]

the most serious risks of blood product transfusion (hep c - 1/60k, hiv 1/500k) are exponentially lower than the risks of GA for joint replacement. The risks of a potentially difficult femoral nerve block (obese) in patients with altered coagulation is not well delineated by ASRA.

additionally, without an epidural this patient will be exposed to the risks of high dose PCA opioids (resp depression, atelectasis) and only achieve mediocre pain control, resulting in delayed/suboptimal early rehab.

lastly, a normal PTT is essential in preventing surgical site hematoma.

i am including 1 review, however, the body of evidence is much more vast.

-------------------------------------

Objectives: To obtain reliable estimates of the effects of neuraxial blockade with epidural or spinal anaesthesia on postoperative morbidity and mortality.
Design: Systematic review of all trials with randomisation to intraoperative neuraxial blockade or not.
Studies: 141 trials including 9559 patients for which data were available before 1 January 1997. Trials were eligible irrespective of their primary aims, concomitant use of general anaesthesia, publication status, or language. Trials were identified by extensive search methods, and substantial amounts of data were obtained or confirmed by correspondence with trialists.
Main outcome measures: All cause mortality, deep vein thrombosis, pulmonary embolism, myocardial infarction, transfusion requirements, pneumonia, other infections, respiratory depression, and renal failure.
Results: Overall mortality was reduced by about a third in patients allocated to neuraxial blockade (103 deaths/4871 patients versus 144/4688 patients, odds ratio=0.70, 95% confidence interval 0.54 to 0.90, P=0.006). Neuraxial blockade reduced the odds of deep vein thrombosis by 44%, pulmonary embolism by 55%, transfusion requirements by 50%, pneumonia by 39%, and respiratory depression by 59% (all P<0.001). There were also reductions in myocardial infarction and renal failure. Although there was limited power to assess subgroup effects, the proportional reductions in mortality did not clearly differ by surgical group, type of blockade (epidural or spinal), or in those trials in which neuraxial blockade was combined with general anaesthesia compared with trials in which neuraxial blockade was used alone.
Conclusions: Neuraxial blockade reduces postoperative mortality and other serious complications. The size of some of these benefits remains uncertain, and further research is required to determine whether these effects are due solely to benefits of neuraxial blockade or partly to avoidance of general anaesthesia. Nevertheless, these findings support more widespread use of neuraxial blockade.

MJ 2000;321:1493 ( 16 December )
Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials

 

[toughlife]

the most serious risks of blood product transfusion (hep c - 1/60k, hiv 1/500k) are exponentially lower than the risks of GA for joint replacement. The risks of a potentially difficult femoral nerve block (obese) in patients with altered coagulation is not well delineated by ASRA.

additionally, without an epidural this patient will be exposed to the risks of high dose PCA opioids (resp depression, atelectasis) and only achieve mediocre pain control, resulting in delayed/suboptimal early rehab.

lastly, a normal PTT is essential in preventing surgical site hematoma.

i am including 1 review, however, the body of evidence is much more vast.

-------------------------------------

Objectives: To obtain reliable estimates of the effects of neuraxial blockade with epidural or spinal anaesthesia on postoperative morbidity and mortality.
Design: Systematic review of all trials with randomisation to intraoperative neuraxial blockade or not.
Studies: 141 trials including 9559 patients for which data were available before 1 January 1997. Trials were eligible irrespective of their primary aims, concomitant use of general anaesthesia, publication status, or language. Trials were identified by extensive search methods, and substantial amounts of data were obtained or confirmed by correspondence with trialists.
Main outcome measures: All cause mortality, deep vein thrombosis, pulmonary embolism, myocardial infarction, transfusion requirements, pneumonia, other infections, respiratory depression, and renal failure.
Results: Overall mortality was reduced by about a third in patients allocated to neuraxial blockade (103 deaths/4871 patients versus 144/4688 patients, odds ratio=0.70, 95% confidence interval 0.54 to 0.90, P=0.006). Neuraxial blockade reduced the odds of deep vein thrombosis by 44%, pulmonary embolism by 55%, transfusion requirements by 50%, pneumonia by 39%, and respiratory depression by 59% (all P<0.001). There were also reductions in myocardial infarction and renal failure. Although there was limited power to assess subgroup effects, the proportional reductions in mortality did not clearly differ by surgical group, type of blockade (epidural or spinal), or in those trials in which neuraxial blockade was combined with general anaesthesia compared with trials in which neuraxial blockade was used alone.
Conclusions: Neuraxial blockade reduces postoperative mortality and other serious complications. The size of some of these benefits remains uncertain, and further research is required to determine whether these effects are due solely to benefits of neuraxial blockade or partly to avoidance of general anaesthesia. Nevertheless, these findings support more widespread use of neuraxial blockade.

MJ 2000;321:1493 ( 16 December )
Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials

You can minimize the risk of difficulty of the FNB by using U/S. Heck why not even drop a catheter in while you're at it.

 

[toughlife]

the most serious risks of blood product transfusion (hep c - 1/60k, hiv 1/500k) are exponentially lower than the risks of GA for joint replacement. The risks of a potentially difficult femoral nerve block (obese) in patients with altered coagulation is not well delineated by ASRA.

additionally, without an epidural this patient will be exposed to the risks of high dose PCA opioids (resp depression, atelectasis) and only achieve mediocre pain control, resulting in delayed/suboptimal early rehab.

lastly, a normal PTT is essential in preventing surgical site hematoma.

i am including 1 review, however, the body of evidence is much more vast.

-------------------------------------

Objectives: To obtain reliable estimates of the effects of neuraxial blockade with epidural or spinal anaesthesia on postoperative morbidity and mortality.
Design: Systematic review of all trials with randomisation to intraoperative neuraxial blockade or not.
Studies: 141 trials including 9559 patients for which data were available before 1 January 1997. Trials were eligible irrespective of their primary aims, concomitant use of general anaesthesia, publication status, or language. Trials were identified by extensive search methods, and substantial amounts of data were obtained or confirmed by correspondence with trialists.
Main outcome measures: All cause mortality, deep vein thrombosis, pulmonary embolism, myocardial infarction, transfusion requirements, pneumonia, other infections, respiratory depression, and renal failure.
Results: Overall mortality was reduced by about a third in patients allocated to neuraxial blockade (103 deaths/4871 patients versus 144/4688 patients, odds ratio=0.70, 95% confidence interval 0.54 to 0.90, P=0.006). Neuraxial blockade reduced the odds of deep vein thrombosis by 44%, pulmonary embolism by 55%, transfusion requirements by 50%, pneumonia by 39%, and respiratory depression by 59% (all P<0.001). There were also reductions in myocardial infarction and renal failure. Although there was limited power to assess subgroup effects, the proportional reductions in mortality did not clearly differ by surgical group, type of blockade (epidural or spinal), or in those trials in which neuraxial blockade was combined with general anaesthesia compared with trials in which neuraxial blockade was used alone.
Conclusions: Neuraxial blockade reduces postoperative mortality and other serious complications. The size of some of these benefits remains uncertain, and further research is required to determine whether these effects are due solely to benefits of neuraxial blockade or partly to avoidance of general anaesthesia. Nevertheless, these findings support more widespread use of neuraxial blockade.

MJ 2000;321:1493 ( 16 December )
Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials

duplicate

 

[Noyac]

the most serious risks of blood product transfusion (hep c - 1/60k, hiv 1/500k) are exponentially lower than the risks of GA for joint replacement. The risks of a potentially difficult femoral nerve block (obese) in patients with altered coagulation is not well delineated by ASRA.

additionally, without an epidural this patient will be exposed to the risks of high dose PCA opioids (resp depression, atelectasis) and only achieve mediocre pain control, resulting in delayed/suboptimal early rehab.

lastly, a normal PTT is essential in preventing surgical site hematoma.

i am including 1 review, however, the body of evidence is much more vast.

-------------------------------------

Objectives: To obtain reliable estimates of the effects of neuraxial blockade with epidural or spinal anaesthesia on postoperative morbidity and mortality.
Design: Systematic review of all trials with randomisation to intraoperative neuraxial blockade or not.
Studies: 141 trials including 9559 patients for which data were available before 1 January 1997. Trials were eligible irrespective of their primary aims, concomitant use of general anaesthesia, publication status, or language. Trials were identified by extensive search methods, and substantial amounts of data were obtained or confirmed by correspondence with trialists.
Main outcome measures: All cause mortality, deep vein thrombosis, pulmonary embolism, myocardial infarction, transfusion requirements, pneumonia, other infections, respiratory depression, and renal failure.
Results: Overall mortality was reduced by about a third in patients allocated to neuraxial blockade (103 deaths/4871 patients versus 144/4688 patients, odds ratio=0.70, 95% confidence interval 0.54 to 0.90, P=0.006). Neuraxial blockade reduced the odds of deep vein thrombosis by 44%, pulmonary embolism by 55%, transfusion requirements by 50%, pneumonia by 39%, and respiratory depression by 59% (all P<0.001). There were also reductions in myocardial infarction and renal failure. Although there was limited power to assess subgroup effects, the proportional reductions in mortality did not clearly differ by surgical group, type of blockade (epidural or spinal), or in those trials in which neuraxial blockade was combined with general anaesthesia compared with trials in which neuraxial blockade was used alone.
Conclusions: Neuraxial blockade reduces postoperative mortality and other serious complications. The size of some of these benefits remains uncertain, and further research is required to determine whether these effects are due solely to benefits of neuraxial blockade or partly to avoidance of general anaesthesia. Nevertheless, these findings support more widespread use of neuraxial blockade.

MJ 2000;321:1493 ( 16 December )
Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials

I can't wait for Mil's response to this one.

But I will comment on this: "additionally, without an epidural this patient will be exposed to the risks of high dose PCA opioids (resp depression, atelectasis) and only achieve mediocre pain control, resulting in delayed/suboptimal early rehab." This is a crock and I am a BIG proponent of regional anesthesia. We have all (and if you haven't , you will) seen the pt with the working epidural that you just can't get completely comfortable. What do we do? We pull the epidural and start a PCA and they 9 times out of 10 are much happier. PCA'S still work very very well.

 

[coprolalia]

Has anyone EVER PERSONALLY seen an epidural hematoma FROM:

- a spinal
- epidural
- lumbar puncture
- myelogram
- or other procedures where we stick a needle in someone's back.

Yes. Chick had to go to the OR for a spinal decompression. It was a trainwreck.

-copro

 

[VentdependenT]

the most serious risks of blood product transfusion (hep c - 1/60k, hiv 1/500k) are exponentially lower than the risks of GA for joint replacement. The risks of a potentially difficult femoral nerve block (obese) in patients with altered coagulation is not well delineated by ASRA.

additionally, without an epidural this patient will be exposed to the risks of high dose PCA opioids (resp depression, atelectasis) and only achieve mediocre pain control, resulting in delayed/suboptimal early rehab.

lastly, a normal PTT is essential in preventing surgical site hematoma.

i am including 1 review, however, the body of evidence is much more vast.

-------------------------------------

Objectives: To obtain reliable estimates of the effects of neuraxial blockade with epidural or spinal anaesthesia on postoperative morbidity and mortality.
Design: Systematic review of all trials with randomisation to intraoperative neuraxial blockade or not.
Studies: 141 trials including 9559 patients for which data were available before 1 January 1997. Trials were eligible irrespective of their primary aims, concomitant use of general anaesthesia, publication status, or language. Trials were identified by extensive search methods, and substantial amounts of data were obtained or confirmed by correspondence with trialists.
Main outcome measures: All cause mortality, deep vein thrombosis, pulmonary embolism, myocardial infarction, transfusion requirements, pneumonia, other infections, respiratory depression, and renal failure.
Results: Overall mortality was reduced by about a third in patients allocated to neuraxial blockade (103 deaths/4871 patients versus 144/4688 patients, odds ratio=0.70, 95% confidence interval 0.54 to 0.90, P=0.006). Neuraxial blockade reduced the odds of deep vein thrombosis by 44%, pulmonary embolism by 55%, transfusion requirements by 50%, pneumonia by 39%, and respiratory depression by 59% (all P<0.001). There were also reductions in myocardial infarction and renal failure. Although there was limited power to assess subgroup effects, the proportional reductions in mortality did not clearly differ by surgical group, type of blockade (epidural or spinal), or in those trials in which neuraxial blockade was combined with general anaesthesia compared with trials in which neuraxial blockade was used alone.
Conclusions: Neuraxial blockade reduces postoperative mortality and other serious complications. The size of some of these benefits remains uncertain, and further research is required to determine whether these effects are due solely to benefits of neuraxial blockade or partly to avoidance of general anaesthesia. Nevertheless, these findings support more widespread use of neuraxial blockade.

MJ 2000;321:1493 ( 16 December )
Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials

Regional is great. However current evidence doesn't provide it with the power to supplant GA..at least not yet. Thats for sure. It certainly doesn't do much for abdominal surgery outcomes.

A femoral nerve block with U/S is easy. A catheter can be left in and the patient will have most of their pain covered and still be able to do rehab/deep cough as with an epidural.

I don't think subjecting people to ELECTIVE transfusions is warranted. I'd rather have pain then be exposed to 20 different donor's antibodies (thanks FFP), HIV, Hepatitis, and alloimmunization just so I could have a friggen spinal. Especially if it isn't truely needed. WHich is isn't.

DVT prophylaxis should be done with lovenox/heparin/argatroban (for HIT folks). Not a neuraxial.

CAD guy needs BETABLOCKERS and ASA, not an epidural.

 

[militarymd]

I can't wait for Mil's response to this one.

But I will comment on this: "additionally, without an epidural this patient will be exposed to the risks of high dose PCA opioids (resp depression, atelectasis) and only achieve mediocre pain control, resulting in delayed/suboptimal early rehab." This is a crock and I am a BIG proponent of regional anesthesia. We have all (and if you haven't , you will) seen the pt with the working epidural that you just can't get completely comfortable. What do we do? We pull the epidural and start a PCA and they 9 times out of 10 are much happier. PCA'S still work very very well.

hory clap....is this the second coming of the middle ages?????

 

[jetproppilot]

HORY clap....is this the second coming of the middle ages?????

"AHHHHHH, MASTA, CHINESE ACCENT STILL INTACT!!!!"

reminds me of my OB/GYN buddy who did his residency with a buddy of his named Dat, an oriental dude who would get his panties in a wad if he was late....my buddy did a great impersonation of Dat, which included:

"HORY SH I T!! ITS FREE O CROCK!!! I GOTTA GO TO CRINIC!!!!"



hahahahahhaahah......god i'm so easily amused....

 

[militarymd]

Yes. Chick had to go to the OR for a spinal decompression. It was a trainwreck.

-copro

details ??

 

[VentdependenT]

"AHHHHHH, MASTA, CHINESE ACCENT STILL INTACT!!!!"

reminds me of my OB/GYN buddy who did his residency with a buddy of his named Dat, an oriental dude who would get his panties in a wad if he was late....my buddy did a great impersonation of Dat, which included:

"HORY SH I T!! ITS FREE O CROCK!!! I GOTTA GO TO CRINIC!!!!"



hahahahahhaahah......god i'm so easily amused....

I think I'll name my kid Dat.

Boy or girl, I think it serves em both well. Especially with my last name. Could create a new super hero.

 

[Jeff05]

it would be useful if anyone would post studies/case reports/any objective evidence supporting their opinion. anecdotal evidence from personal experience disguised as gospel = the second coming of the middle ages.

i practice evidence based medicine mixed with a healthy dose of common sense. and i have learned that there are 100 ways to do the same thing, safely and therefore respect the professional opinion of others.

respectful discourse would be nice.

 

[militarymd]

it would be useful if anyone would post studies/case reports/any objective evidence supporting their opinion. anecdotal evidence from personal experience disguised as gospel = the second coming of the middle ages.

i practice evidence based medicine mixed with a healthy dose of common sense. and i have learned that there are 100 ways to do the same thing, safely and therefore respect the professional opinion of others.

respectful discourse would be nice.

 

[Planktonmd]

it would be useful if anyone would post studies/case reports/any objective evidence supporting their opinion. anecdotal evidence from personal experience disguised as gospel = the second coming of the middle ages.

i practice evidence based medicine mixed with a healthy dose of common sense. and i have learned that there are 100 ways to do the same thing, safely and therefore respect the professional opinion of others.

respectful discourse would be nice.

Well said.

 

[militarymd]

it would be useful if anyone would post studies/case reports/any objective evidence supporting their opinion. anecdotal evidence from personal experience disguised as gospel = the second coming of the middle ages.

i practice evidence based medicine mixed with a healthy dose of common sense. and i have learned that there are 100 ways to do the same thing, safely and therefore respect the professional opinion of others.

respectful discourse would be nice.

All of those benefits that regional supposedly has over GA has pretty much been debunked since 2000.

There may be some minor benefits, but the numbers are clearly not what was in that reference.

AAA surgery double blind prospective study comparing epidural / ga.....NO difference....that was the best study.....many others....

with the advent of lmwh...and effective DVT prophylasis.....all those benefits of regional is hx.

 

[toughlife]

All of those benefits that regional supposedly has over GA has pretty much been debunked since 2000.

There may be some minor benefits, but the numbers are clearly not what was in that reference.

AAA surgery double blind prospective study comparing epidural / ga.....NO difference....that was the best study.....many others....

with the advent of lmwh...and effective DVT prophylasis.....all those benefits of regional is hx.

Hey MMD, what do you read to stay abreast of all these studies?

 

[militarymd]

Hey MMD, what do you read to stay abreast of all these studies?

when I was in the Navy, I spend about 4 hours a day reading:

anesthesia/analgesia
am j res & ccm
nejm
annals of IM
circulation
chest
+ others I can't remember on a regular basis...

other stuff based on talks I'm working on and references that need to be pulled.

Some of the orignial articles can be a pain in the a ss because the book stacks don't have them...

Currently, I don't do di ck, other than argue with Plank here.

 

[Planktonmd]

when I was in the Navy, I spend about 4 hours a day reading:

anesthesia/analgesia
am j res & ccm
nejm
annals of IM
circulation
chest
+ others I can't remember on a regular basis...

other stuff based on talks I'm working on and references that need to be pulled.

Some of the orignial articles can be a pain in the a ss because the book stacks don't have them...

Currently, I don't do di ck, other than argue with Plank here.

🙄
Still not commenting!