2010 ASRA接受抗栓或溶栓治疗患者的区域麻醉指南 美国区域麻醉与疼痛医学协会循症指南(第3版)

中文标题：

2010 ASRA接受抗栓或溶栓治疗患者的区域麻醉指南 美国区域麻醉与疼痛医学协会循症指南(第3版)

英文标题：

Regional Anesthesia in the Patient Receiving An tithrombotic or Thrombolytic Therapy American Society of Regional Anesthesia and Pain Medicine Evidence—Based Guidelines(Third Edition)

发布机构：

美国区域麻醉和疼痛医学学会

发布日期：

2010-01-02

简要介绍：

Abstract: The actual incidence of neurologic dysfunction resultingfrom hemorrhagic complications associated with neuraxial blockade isunknown. Although the incidence cited in the literature is estimated tobe less than 1 in 150,000 epidural and less than 1 in 220,000 spinalanesthetics, recent epidemiologic surveys suggest that the frequency isincreasing and may be as high as 1 in 3000 in some patient populations.Overall, the risk of clinically significant bleeding increase with age,associated abnormalities of the spinal cord or vertebral column, thepresence of an underlying coagulopathy, difficulty during needle placement,and an indwelling neuraxial catheter during sustained anticoagulation( particularly with standard heparin or low-molecular weightheparin). The need for prompt diagnosis and intervention to optimizeneurologic outcome is also consistently reported.In response to these patient safety issues, the American Society ofRegional Anesthesia and Pain Medicine (ASRA) convened its ThirdConsensus Conference on Regional Anesthesia and Anticoagulation.Practice guidelines or recommendations summarize evidence-basedreviews. However, the rarity of spinal hematoma defies a prospectiverandomized study, and there is no current laboratory model. As a result,the ASRA consensus statements represent the collective experienceof recognized experts in the field of neuraxial anesthesia andanticoagulation. These are based on case reports, clinical series, pharmacology,hematology, and risk factors for surgical bleeding. Anunderstanding of the complexity of this issue is essential to patientmanagement.