Dataset Information

Incidence of epidural haematoma and neurological injury in cardiovascular patients with epidural analgesia/anaesthesia: systematic review and meta-analysis.

ABSTRACT:

Background

Epidural anaesthesia is used extensively for cardiothoracic and vascular surgery in some centres, but not in others, with argument over the safety of the technique in patients who are usually extensively anticoagulated before, during, and after surgery. The principle concern is bleeding in the epidural space, leading to transient or persistent neurological problems.

Methods

We performed an extensive systematic review to find published cohorts of use of epidural catheters during vascular, cardiac, and thoracic surgery, using electronic searching, hand searching, and reference lists of retrieved articles.

Results

Twelve studies included 14,105 patients, of whom 5,026 (36%) had vascular surgery, 4,971 (35%) cardiac surgery, and 4,108 (29%) thoracic surgery. There were no cases of epidural haematoma, giving maximum risks following epidural anaesthesia in cardiac, thoracic, and vascular surgery of 1 in 1,700, 1 in 1,400 and 1 in 1,700 respectively. In all these surgery types combined the maximum expected rate would be 1 in 4,700. In all these patients combined there were eight cases of transient neurological injury, a rate of 1 in 1,700 (95% confidence interval 1 in 3,300 to 1 in 850). There were no cases of persistent neurological injury (maximum expected rate 1 in 4,600).

Conclusion

These estimates for cardiothoracic epidural anaesthesia should be the worst case. Limitations are inadequate denominators for different types of surgery in anticoagulated cardiothoracic or vascular patients more at risk of bleeding.

SUBMITTER: Ruppen W

PROVIDER: S-EPMC1586186 | biostudies-literature | 2006 Sep

REPOSITORIES: biostudies-literature

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Publications

Incidence of epidural haematoma and neurological injury in cardiovascular patients with epidural analgesia/anaesthesia: systematic review and meta-analysis.

Ruppen Wilhelm W Derry Sheena S McQuay Henry J HJ Moore R Andrew RA

BMC anesthesiology 20060912

<h4>Background</h4>Epidural anaesthesia is used extensively for cardiothoracic and vascular surgery in some centres, but not in others, with argument over the safety of the technique in patients who are usually extensively anticoagulated before, during, and after surgery. The principle concern is bleeding in the epidural space, leading to transient or persistent neurological problems.<h4>Methods</h4>We performed an extensive systematic review to find published cohorts of use of epidural catheter ...[more]

PMID: 16968537

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Project description:Study designSystematic review and meta-analysis.ObjectiveTo determine the difference in cardiovascular risk factors (blood pressure, lipid profile, and markers of glucose metabolism and inflammation) according to the neurological level of spinal cord injury (SCI).MethodsWe searched 5 electronic databases from inception until July 4, 2020. Data were extracted by two independent reviewers using a pre-defined data collection form. The pooled effect estimate was computed using random-effects models, and heterogeneity was calculated using I2 statistic and chi-squared test (CRD42020166162).ResultsWe screened 4863 abstracts, of which 47 studies with 3878 participants (3280 males, 526 females, 72 sex unknown) were included in the meta-analysis. Compared to paraplegia, individuals with tetraplegia had lower systolic and diastolic blood pressure (unadjusted weighted mean difference, -14.5 mmHg, 95% CI -19.2, -9.9; -7.0 mmHg 95% CI -9.2, -4.8, respectively), lower triglycerides (-10.9 mg/dL, 95% CI -19.7, -2.1), total cholesterol (-9.9 mg/dL, 95% CI -14.5, -5.4), high-density lipoprotein (-1.7 mg/dL, 95% CI -3.3, -0.2) and low-density lipoprotein (-5.8 mg/dL, 95% CI -9.0, -2.5). Comparing individuals with high- vs. low-thoracic SCI, persons with higher injury had lower systolic and diastolic blood pressure (-10.3 mmHg, 95% CI -13.4, -7.1; -5.3 mmHg 95% CI -7.5, -3.2, respectively), while no differences were found for low-density lipoprotein, serum glucose, insulin, and inflammation markers. High heterogeneity was partially explained by age, prevalent cardiovascular diseases and medication use, body mass index, sample size, and quality of studies.ConclusionIn SCI individuals, the level of injury may be an additional non-modifiable cardiovascular risk factor. Future well-designed longitudinal studies with sufficient follow-up and providing sex-stratified analyses should confirm our findings and explore the role of SCI level in cardiovascular health and overall prognosis and survival.

Project description:AimWomen during the postpartum period are at risk for psychiatric disorders such as postpartum depression (PPD), post-traumatic stress disorder (PTSD), and anxiety. It is controversial whether labour epidural analgesia have a protective role on PPD, PTSD, and anxiety or not. This study is a meta-analysis of previously published observational studies to investigate the association between epidural analgesia and PPD, PTSD, and anxiety.MethodsWe searched Cochran Library, PubMed, ProQuest, EMBASE, Scopus, Web of Science, PsycINFO, and MEDLINE from inception until December 2022. The outcome measures were positive screen of PPD, PTSD, and anxiety among women who received labour epidural analgesia. The Newcastle-Ottawa Scale was used to assess the quality of the observational studies. Statistical analysis was performed using Stata 17.0 software. The mean differences or odds ratios were pooled based on random effect.ResultsWe included 31 studies (12,064 women) in the review. The meta-analysis of PPD studies reported mean (standard deviation) showed no significant association between epidural analgesia and PPD (Mean Difference = 0.01; 95% Confidence Interval = -0.14 to 0.16; p-value = 0.88). The meta-analysis of PPD studies reported percentage showed no statistically significant difference in terms of the chance of depression between the exposed and non-exposed groups (Log Odds Ratio = -0.61; 95% CI = -1.48 to 0.26; p-value = 0.17). The meta-analysis of PPD studies reported OR showed indicate a lower chance of depression in the epidural group compared to the non-epidural group (Effect size = 1.01; 95% CI = 0.64 to 1.38; P-value = 0.00). In the case of PTSD, due to the heterogeneity of the tools and the methodology of the studies, it was impossible to reach a definitive conclusion and measure the studies in a meta-analysis. The meta-analysis of anxiety studies showed that no significant association between epidural analgesia and anxiety (MD = -1.36; 95% CI = -3.38 to 1.14; p-value = 0.29).ConclusionBased on the meta-analysis of observational studies, epidural analgesia for labour pain relief has no protective effect on postpartum psychiatric disorders.

Dataset Information

Incidence of epidural haematoma and neurological injury in cardiovascular patients with epidural analgesia/anaesthesia: systematic review and meta-analysis.

Background

Methods

Results

Conclusion

Publications

Incidence of epidural haematoma and neurological injury in cardiovascular patients with epidural analgesia/anaesthesia: systematic review and meta-analysis.

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