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• W2028677037 abstract "We wish to resolve the dilemma highlighted by A Williams (Aug 25, p 673)1Williams AE Expectations placed on anaesthetists.Lancet. 2001; 358: 673-674Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar facing anaesthetists about the use of intraoperative and postoperative epidural analgesia in the presence of prophylactic anticoagulation.Williams has no reservations about the efficacy and usefulness of epidural analgesia during the postoperative period but is not sure whether epidural anaesthesia alone confers substantial protection against venous thrombosis, and whether we should continue following the conventional guidelines, which do allow concomitant use of epidurals and prophylactic anti-coagulation.We do not think the first question will ever be resolved with 100% certainty, as for any question or controversy in clinical medicine. In a comprehensive systematic review looking at the effects of neuraxial blockade on postoperative morbidity and mortality, Rodgers and colleagues2Rodgers A Walker N Schug S et al.Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials.BMJ. 2000; 321: 1493Crossref PubMed Google Scholar reported a significant overall reduction of mortality by about one-third in patients assigned neuraxial blockade. Neuraxial blockade reduced the odds of deep-vein thrombosis by 44% and pulmonary embolism by 55%, along with significant reduction in transfusion requirements, pneumonia, and respiratory depression. Rodgers and colleagues are supporting more widespread use of neuraxial blockade.The incidence of neurological dysfunction resulting from haemor-rhagic complications associated with central neural blockade is estimated to be less than one in 150 000 epidurals.3Horlocker TT Low molecular weight heparin and neuraxial anesthesia.Thromb Res. 2001; 101: V141-V154Summary Full Text Full Text PDF PubMed Google Scholar Most of the reported cases are from North America, where much larger doses of low-molecular-weight heparin are used than in Europe, with different intervals between the siting of epidurals and administration of thromboprophylaxsis.4Breivik H Neurological complications in association with spinal and epidural analgesia–again.Acta Anaesthesiol Scan. 1998; 42: 609-613Crossref PubMed Scopus (47) Google ScholarWe believe that enough clinical information is available to facilitate a proper discussion of the risks and benefits associated with this procedure with the concerned patients. This process will further refine the technique of selective deafferentation to speed and improve physiological recovery from major surgery. We wish to resolve the dilemma highlighted by A Williams (Aug 25, p 673)1Williams AE Expectations placed on anaesthetists.Lancet. 2001; 358: 673-674Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar facing anaesthetists about the use of intraoperative and postoperative epidural analgesia in the presence of prophylactic anticoagulation. Williams has no reservations about the efficacy and usefulness of epidural analgesia during the postoperative period but is not sure whether epidural anaesthesia alone confers substantial protection against venous thrombosis, and whether we should continue following the conventional guidelines, which do allow concomitant use of epidurals and prophylactic anti-coagulation. We do not think the first question will ever be resolved with 100% certainty, as for any question or controversy in clinical medicine. In a comprehensive systematic review looking at the effects of neuraxial blockade on postoperative morbidity and mortality, Rodgers and colleagues2Rodgers A Walker N Schug S et al.Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials.BMJ. 2000; 321: 1493Crossref PubMed Google Scholar reported a significant overall reduction of mortality by about one-third in patients assigned neuraxial blockade. Neuraxial blockade reduced the odds of deep-vein thrombosis by 44% and pulmonary embolism by 55%, along with significant reduction in transfusion requirements, pneumonia, and respiratory depression. Rodgers and colleagues are supporting more widespread use of neuraxial blockade. The incidence of neurological dysfunction resulting from haemor-rhagic complications associated with central neural blockade is estimated to be less than one in 150 000 epidurals.3Horlocker TT Low molecular weight heparin and neuraxial anesthesia.Thromb Res. 2001; 101: V141-V154Summary Full Text Full Text PDF PubMed Google Scholar Most of the reported cases are from North America, where much larger doses of low-molecular-weight heparin are used than in Europe, with different intervals between the siting of epidurals and administration of thromboprophylaxsis.4Breivik H Neurological complications in association with spinal and epidural analgesia–again.Acta Anaesthesiol Scan. 1998; 42: 609-613Crossref PubMed Scopus (47) Google Scholar We believe that enough clinical information is available to facilitate a proper discussion of the risks and benefits associated with this procedure with the concerned patients. This process will further refine the technique of selective deafferentation to speed and improve physiological recovery from major surgery." @default.
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• W2028677037 title "Use of epidurals during and after surgery" @default.
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