TIMING IS UNPREDICTABLE AND THE SEVERITY İS UNCERTAİN: REMOVAL OF EPIDURAL CATHETER AFTER POSTOPERATIVE MYOCARDIAL INFARCTION
Diğer yayınlar > Diğer · 2018
Yazarlar: Cagiran Zeynep
Diğer, Uluslararası, 2018,
Özet
TIMING IS UNPREDICTABLE AND THE SEVERITY u0130S UNCERTAu0130N: Removal Of Epidural Catheter After Postoperative Myocardial Infarction Zeynep CAGIRAN, Nezih SERTOZ, Semra KARAMANDepartment of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, u0130zmir, Turkey PURPOSE: Management of perioperative myocardial infarction(MI) becomes more complicated with neuraxial techniques and anticoagulation therapy(1). We present a case of safe removal of an epidural catheter; 33 hours after oral dual anticaogulan and low molecular weight heparin (LMWH) therapy with a normal coagulation function analysis before removal. A 42 year old woman underwent total hip arthroplasthy under combined spinal epidural anaesthesia. Her physical examination was normal except inverted T waves in V1-4 on electrocardiogram(ECG). On arrival to postanesthesia care unit ECG revealed bigeminy ventricular extrasystole without ST segment elevation. After the rising in troponin I, patient transferred to coronary intensive care unit with the diagnosis of nonst-segment elevation MI. Dual oral antiplatelet therapy and LMWH were started. The removal of epidural catheter required a clinical decision, balancing the risk of epidural hematoma with continuation of antiplatelet therapy against the risk of thrombosis with discontinuation of the medication. Clopidogrel was immediately discontinued but the patient continued to receive LMWH twice a day with the last dose being 24 hours before the planned epidural catheter removal. On the second postoperative day after routine coagulation tests, the catheter was removed uneventfully. She was discharged home in the postoperative 13th day. The timing for removal of an epidural catheter in anticoagulated patients is still a very hard decision if further coagulation and aggregation tests are not available. Considering a reasonable balance of minimizing the risk of epidural hematoma and the risks of thromboembolic events, the catheter removal may be likely be less than 36 hours. 1. Glenn E, Mehl J, Rosinia FA, Liu H. Safe removal of an epidural catheter 72 hours after clopidogrel and aspirin administrations guided by platelet function analysis and thromboelastography. J Anaesthesiol Clin Pharmacol. 2013;1:99u2013101.