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6 results on '"Wethington, Kevin L."'

1. Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients : A Report from the Multicenter Perioperative Outcomes Group

Author

Lee, Linden O., Bateman, Brian T., Kheterpal, Sachin, Klumpner, Thomas T., Housey, Michelle, Aziz, Michael F., Hand, Karen W., MacEachern, Mark, Goodier, Christopher G., Bernstein, Jeffrey, Bauer, Melissa E., Lirk, Philip, Wilczak, Janet, Soto, Roy, Tom, Simon, Cuff, Germaine, Biggs, Daniel A., Coffman, Traci, Saager, Leif, Levy, Warren J., Godbold, Michael, Pace, Nathan L., Wethington, Kevin L., Paganelli, William C., Durieux, Marcel E., Domino, Karen B., Nair, Bala, Ehrenfeld, Jesse M., Wanderer, Jonathan P., Schonberger, Robert B., Berris, Joshua, Lins, Steven, Coles, Peter, Cummings, Kenneth C., Maheshwari, Kamal, Berman, Mitchell F., Wedeven, Christopher, LaGorio, John, Fleishut, Peter M., Ellis, Terri A., Molina, Susan, Carl, Curtis, Kadry, Bassam, van Klei, Wilton A A, Pasma, Wietze, Jameson, Leslie C., Helsten, Daniel L., and Avidan, Michael S.

Subjects
Multicenter Study, Anesthesiology and Pain Medicine, Journal Article, Observational Study
Abstract

BACKGROUND:: Thrombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. There is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. The authors reviewed a large perioperative database and performed a systematic review to further define the risk of epidural hematoma requiring surgical decompression in this population. METHODS:: The authors performed a retrospective cohort study using the Multicenter Perioperative Outcomes Group database to identify thrombocytopenic parturients who received a neuraxial technique and to estimate the risk of epidural hematoma. Patients were stratified by platelet count, and those requiring surgical decompression were identified. A systematic review was performed, and risk estimates were combined with those from the existing literature. RESULTS:: A total of 573 parturients with a platelet count less than 100,000 mm who received a neuraxial technique across 14 institutions were identified in the Multicenter Perioperative Outcomes Group database, and a total of 1,524 parturients were identified after combining the data from the systematic review. No cases of epidural hematoma requiring surgical decompression were observed. The upper bound of the 95% CI for the risk of epidural hematoma for a platelet count of 0 to 49,000 mm is 11%, for 50,000 to 69,000 mm is 3%, and for 70,000 to 100,000 mm is 0.2%. CONCLUSIONS:: The number of thrombocytopenic parturients in the literature who received neuraxial techniques without complication has been significantly increased. The risk of epidural hematoma associated with neuraxial techniques in parturients at a platelet count less than 70,000 mm remains poorly defined due to limited observations.

Published
2017

2. Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients: A Report from the Multicenter Perioperative Outcomes Group

Author

Medische staf Anesthesiologie, Circulatory Health, Management Vitale Functies, Trialbureau Vitale Functies, Lee, Linden O., Bateman, Brian T., Kheterpal, Sachin, Klumpner, Thomas T., Housey, Michelle, Aziz, Michael F., Hand, Karen W., MacEachern, Mark, Goodier, Christopher G., Bernstein, Jeffrey, Bauer, Melissa E., Lirk, Philip, Wilczak, Janet, Soto, Roy, Tom, Simon, Cuff, Germaine, Biggs, Daniel A., Coffman, Traci, Saager, Leif, Levy, Warren J., Godbold, Michael, Pace, Nathan L., Wethington, Kevin L., Paganelli, William C., Durieux, Marcel E., Domino, Karen B., Nair, Bala, Ehrenfeld, Jesse M., Wanderer, Jonathan P., Schonberger, Robert B., Berris, Joshua, Lins, Steven, Coles, Peter, Cummings, Kenneth C., Maheshwari, Kamal, Berman, Mitchell F., Wedeven, Christopher, LaGorio, John, Fleishut, Peter M., Ellis, Terri A., Molina, Susan, Carl, Curtis, Kadry, Bassam, van Klei, Wilton A A, Pasma, Wietze, Jameson, Leslie C., Helsten, Daniel L., Avidan, Michael S., Medische staf Anesthesiologie, Circulatory Health, Management Vitale Functies, Trialbureau Vitale Functies, Lee, Linden O., Bateman, Brian T., Kheterpal, Sachin, Klumpner, Thomas T., Housey, Michelle, Aziz, Michael F., Hand, Karen W., MacEachern, Mark, Goodier, Christopher G., Bernstein, Jeffrey, Bauer, Melissa E., Lirk, Philip, Wilczak, Janet, Soto, Roy, Tom, Simon, Cuff, Germaine, Biggs, Daniel A., Coffman, Traci, Saager, Leif, Levy, Warren J., Godbold, Michael, Pace, Nathan L., Wethington, Kevin L., Paganelli, William C., Durieux, Marcel E., Domino, Karen B., Nair, Bala, Ehrenfeld, Jesse M., Wanderer, Jonathan P., Schonberger, Robert B., Berris, Joshua, Lins, Steven, Coles, Peter, Cummings, Kenneth C., Maheshwari, Kamal, Berman, Mitchell F., Wedeven, Christopher, LaGorio, John, Fleishut, Peter M., Ellis, Terri A., Molina, Susan, Carl, Curtis, Kadry, Bassam, van Klei, Wilton A A, Pasma, Wietze, Jameson, Leslie C., Helsten, Daniel L., and Avidan, Michael S.

Published
2017

4. The risk and outcomes of epidural hematomas after perioperative and obstetric epidural catheterization: a report from the Multicenter Perioperative Outcomes Group Research Consortium.

Author

Bateman BT, Mhyre JM, Ehrenfeld J, Kheterpal S, Abbey KR, Argalious M, Berman MF, Jacques PS, Levy W, Loeb RG, Paganelli W, Smith KW, Wethington KL, Wax D, Pace NL, Tremper K, and Sandberg WS

Subjects
Aged, Aged, 80 and over, Female, Hematoma, Epidural, Spinal surgery, Humans, Laminectomy, Middle Aged, Perioperative Period, Pregnancy, Risk, Anesthesia, Epidural adverse effects, Catheterization adverse effects, Hematoma, Epidural, Spinal etiology
Abstract

Background: In this study, we sought to determine the frequency and outcomes of epidural hematomas after epidural catheterization., Methods: Eleven centers participating in the Multicenter Perioperative Outcomes Group used electronic anesthesia information systems and quality assurance databases to identify patients who had epidural catheters inserted for either obstetrical or surgical indications. From this cohort, patients undergoing laminectomy for the evacuation of hematoma within 6 weeks of epidural placement were identified., Results: Seven of 62,450 patients undergoing perioperative epidural catheterizations developed hematoma requiring surgical evacuation. The event rate was 11.2 × 10(-5) (95% confidence interval [CI], 4.5 × 10(-5) to 23.1 × 10(-5)). Four of the 7 had anticoagulation/antiplatelet therapy that deviated from American Society of Regional Anesthesia guidelines. None of 79,837 obstetric patients with epidural catheterizations developed hematoma (upper limit of the 95% CI, 4.6 × 10(-5)). The hematoma rate in obstetric epidural catheterizations was significantly lower than in perioperative epidural catheterizations (P = 0.003)., Conclusions: In this series, the 95% CI for the frequency of epidural hematoma requiring laminectomy after epidural catheter placement for perioperative anesthesia/analgesia was 1 event per 22,189 placements to 1 event per 4330 placements. Risk was significantly lower in obstetric epidurals.

Published
2013
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