medigraphic.com

2009, Number S2

Rev Mex Anest 2009; 32 (S2)

Guía de Práctica Clínica Basada en la Evidencia para el Manejo de Anestesia Regional y Anticoagulación

Carrillo ER, Zaragoza LG, Mejía GE, Rivera FJ, Moyao GD, Genis RMÁ, Ortiz MD, Suárez MMPB, Tenopala VS, Covarrubias GA, Marrón PM, Silva BL, García RW, Márquez GJ, Rentería E, Garduño Á, Panoso A, López LL

Language: Spanish
References: 47
Page: 247-276
PDF size: 372.37 Kb.


ABSTRACT

Objective: To develop an up to date, evidence-based Guide which can provide recommendations for the adequate management of regional anesthesia in patients medigraphic Artemeni lsínaea Revista Mexicana de Anestesiología Guía para el manejo de anestesia regional y anticoagulación S248 who are receiving anticoagulant or antithrombotic treatment and which can become applicable to different anesthetic procedures through a Consenso Mexicano de Anestesia Regional y Anticoagulación (Mexican Consensus on Regional Anesthesia and Anticoagulation). Material and methods: For the development of the guide, clinical reviews and analyses were carried out to find biomedical literature and information, as well as systematic examinations of studies considered pertinent by means of an electronic search of all studies related to the themes proposed by the experts, eliminating those studies which did not meet inclusion criteria. The experts also included the secondary references identified in studies found through the electronic searches. Those studies which served as the foundation for the recommendations were evaluated in accordance to the GRADE Working Group by the participating experts. Results: Fourteen expert anesthesiologists and four high specialization residents participated in the development of the guide. This group of 18 participants defined the scope of the guide, the topics to be evaluated and the pertinent questions which needed to be addressed. There were nine work topics designated for the experts: coagulation mechanisms, coagulation path models, coagulation tests, general classification of medications which modify coagulation, neuraxial anatomy, definition of intraspinal hematoma, hematoma risk factors, regional analgesia and anesthesia, and special groups. Each topic was developed in order to respond to the question specified by the group of experts, and included complementary charts and figures. Conclusions: It is necessary for the anesthesiologist to be aware of the possible complications arising from the use of new antiplatelet/anticoagulant medications. The Mexican group advises compliance with the guidelines established by the Spanish Consensus, due to the genetic similarity. The use of a regional technique for prophylactic anticoagulation within the surgical arena is a clinical decision; however, it is essential to carry out a risk-benefit analysis of the necessity of a regional anesthetic technique, and to include close monitoring, a careful placement of catheters, withdrawal in optimal time and close supervision of signs of neurosensitivity in order to reduce the risk of complications.


REFERENCES

  1. Allen DJ, Chae-Kim SH, Trousdale DM. Risks and complications of neuraxial anesthesia and the use of anticoagulation in the surgical patient. Proc (Bayl Univ Med Cent) 2002;15:369-373.

  2. Horlocker TT, Wedel DJ, Benzon H, Brown DL, Enneking FK, Heit JA, Mulroy MF, Rosenquist RW, Rowlingson J, Tryba M, Yuan CS. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med 2003;28:172-197.

  3. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-926.

  4. Martínez-Murillo. Mecanismos de activación de la coagulación. Rev Med Inst Mex Seguro Soc 2006;44:51-58.

  5. Carrillo-Esper, Villaseñor-Ovies. Coagulopatía del paciente quirúrgico. El nuevo modelo celular de la coagulación y su aplicación en Anestesiología. Revista Mexicana de Anestesiología 2004;27:219-230.

  6. Martínez-Murillo. Enfermedad tromboembólica venosa: Guía práctica. Editorial Alfil.

  7. Hoffman M, Monroe DM. Coagulation 2006: A modern view of hemostasis. Hematol Oncol Clin N Am 2007;21:1-11.

  8. Llau J. Exigencia de los valores de coagulación para la realización de bloqueos periféricos. Hospital Clínico Universitario de Valencia: 148-154.

  9. Llau J, et al. Fármacos que alteran la hemostasia y técnicas regionales anestésicas y analgésicas: recomendaciones de seguridad (foro de consenso). Rev Soc Esp Dolor 2001;8:337-348.

  10. Ti LK, Cheong KF, Chen FG. Prediction of excessiafter central neuraxial blockades in Sweden 1990-1999. Anesthesiology 2004;101:950-959.

  11. Hirsh J, et al. Antithrombotic and thrombolytic therapy. American College of CHEST Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). CHEST 2008; 133:110S-112S.

  12. Brinkhous KM. Smth HP, et al. The inhibition of blood clotting: an unidentified substance which acts in conjunction with heparin to prevent the conversion of prothrombin into thrombin. Am J Physiol 1939;125:683-687.

  13. Hirsch J, Anand S, Fuster V. Mechanism of action and pharmacology of unfractionated heparin. Arterioscler. Thromb Vasc Biol 2001;21:1094­1196.

  14. Hirsch J, Raschke R. Heparin and low-molecular-weight heparin: The seventh ACCP conference on antithrombotic and thrombolytic therapy. CHEST 2004;126:188-203.

  15. Pravinkumar E, Webster NR. HIT/HITT and alternative anticoagulation: current concepts. Br J Anaesth 2003;90:676-85.

  16. Hardman J, et al. Goodman & Guilman. Las bases farmacológicas de la terapéutica. McGraw Hill 10ª ed. 2003:1547-1550.

  17. Llau JV, de Andrés J, Gomar C, Gómez A, Hidalgo F, Sahagún J, Torres LM. Drugs that alter hemostasis and regional anesthetic techniques: safety guidelines. Consensus conference. Rev Esp Anestesiol Reanim 2001;48:270-278.

  18. Kopp, Horlocker S. Anticoagulation in pregnancy and neuroaxial blocks. Anesthesiology Clin 2008; 26: 1-22.

  19. Lee C. Seminars in anesthesia, perioperative medicine and pain. Epidural hematomas in the setting of regional anesthesia: Diagnosis, treatment, and prevention. Seminars in Anesthesia, Perioperative Medicine, and Pain, 2003.

  20. Rainer J, Gottschlich B, Stehr S. Spinal epidural hematoma after spinal anesthesia in a patient treated with clopidogrel and enoxaparin. Anesthesiology 2004;101:1467-1470.

  21. Chan L, Bailin M. Spinal epidural hematoma following central neuraxial blockade and subcutaneous enoxaparin: A case report. J Clin Anesth 2004;16:382-385.

  22. Cullen D, Bogdanov E, Htut N. Spinal epidural hematoma occurrence in the absence of known risk factors: A case series. J Clin Anesth 2004;16:376-381.

  23. Cywinski J, Parker B, Lozada L. Spontaneous spinal epidural hematoma in a pregnant patient. J Clin Anesth 2004;16:371-375.

  24. Vandermeulen E, Van Aken H, Vermylen J. Anticoagulant and spinal-epidural anesthesia. Anesthesiology 1994; 79:1165-1177.

  25. Lumpkin M. Reports of epidural or spinal hematomas with the concurrent of low molecular weight heparin and spinal/epidural anesthesia or spinal puncture. FDA Public Health Advisory 12. U.S. Departament of Healt And Human Resources. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/default.htm.

  26. Horlocker T, Heit J.  Low molecular weight heparin Biochemistry, pharmacology, perioperative prophylaxis regimens and guidelines for regional anesthetic management. Anesth Analg 1997; 85: 874-885.

  27. Rodi Z, Štraus I, Deniæ K, Deletis V, Vodušek D. Case report: Transient paraplegia revealed by intraoperative neurophysiological monitoring: Was it caused by the epidural anesthetic or an epidural hematoma? Anesth Analg 2003;96:1785-1788.

  28. Lee L, Posner K, Domino K, Caplan R, Cheney F. Injuries associated with regional anesthesia in the 1980s and 1990s. Anesthesiology 2004; 101:143-152.

  29. Harbury O, Provenzale J, Barboriak D. Vertex epidural hematomas: imaging findinds and diagnostic pitfalls. Eur J Radiol 2000; 36:150–157.

  30. Sternlo JE, Hybbinette CH. Spinal subdural bleeding after attempted epidural and subsequent spinal anesthesia in a patient thrombo-prophylaxis with low molecular weight heparin. Acta Anaesthesiol Scand 1995;39:557-559.

  31. Server A, Tollesson G, Solgaad T, et al. Vertex epidural hematoma neuroradiologic findings and management. Acta Radiol 2002; 43:483–485.

  32. Litz RJ, Hubler M, Koch T, Albrecht D. Spinal-epidural hematoma following epidural anesthesia in the presence of antiplatelet and heparin therapy. Anesthesiology 2001; 95:1031–1033.

  33. Inoue K, Yokoyama M, Nakatsuka H, Goto K. Spontaneous resolution of epidural hematoma after continuous epidural analgesia in a patient without bleeding tendency. Anesthesiology 2002; 97:735–737.

  34. Lee L, et al. Regional anesthesia. Injuries associated with regional anesthesia in the 1980s and 1990s. A closed claims analysis. Anesthesiology 2004;101:143-152.

  35. Moen V, et al. Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 2004;101:950-959.

  36. Roy JD, Massicotte L, Sassine MP, Seal RF, Roy A. A comparison of intrathecal morphine/fentanyl and patient-controlled analgesia with patient-controlled analgesia alone for analgesia after liver resection. Anesth Analg 2006;103:990-994.

  37. Solheim O, Jorgensen JV, Nygaard OP. Lumbar epidural hematoma after chiropractic manipulation for lower-back pain: case report. Neurosurgery 2007;61:E170-E171.

  38. De Pietri L, Siniscalchi A, Reggiani A, Masetti M, Begliomini B, Gazzi M, Gerunda GE, Pasetto A. The use of intrathecal morphine for postoperative pain relief after liver resection: a comparison with epidural analgesia. Anesth Analg 2006;102:1157-1163.

  39. Beattie W, Badner N, Choi P. Epidural analgesia reduces postoperative myocardal infarction: a meta-analysis. Anesth Analg 2001;93:853-858.

  40. Konstantatos A, Silvers AJ, Miles PS. Analgesia best practice after cardiac surgery. Anesthesiol Clin 2008;26:591-602.

  41. Wu CL, et al. Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis. Anesthesiology 2005;103:1079-1088.

  42. Gravlee GP. Epidural analgesia and coronary artery bypass grafting: the controversy continues. J Cardiothoracic Vasc Anesth 2003;17:151-153.

  43. Casalino S, et al. High thoracic epidural anesthesia in cardiac surgery risk factors for arterial hypotension. Text Heart Inst J 2006;33:148-153.

  44. Cuschieri J, et al. Inflammation and the host response to injury a large-scale collaborative project: Patient-oriented research core standard operating procedure for clinical care X. Guidelines for venous thromboembolism prophylaxis in the trauma patient. J Trauma 2008;65:944-950.

  45. Knudson M, Ikossi D. Venous thromboembolism after trauma. Curr Opin Crit Care 2004;10:539-548.

  46. Practice guidelines for chronic pain management. A report by the American Society of Anesthesiologists. Task force on pain management. Chronic Pain Section. Anesthesiology 1997;86: 995-1004.

  47. Tsui SL, Yong BH, Ng KF, Yuen TS, Li CC, Chui KY. Delayed epidural catheter removal: the impact of postoperative coagulopathy. Anaesth Intensive Care 2004;32:630-636.




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