Conclusions
A striking lack of data has always made rational judgement of the balance between the risk of spinal haematoma, and the benefits of perioperative regional anaesthesia and/or analgesia difficult. While new information regarding the benefits of regional anaesthesia is now helping in this cause, the more frequent presentation of patients in whom impaired haemostasis is present, or anticipated, has further complicated the issue. The many states of impaired haemostasis created by drugs and bleeding diathesis, and what is known of their influence on the risk of spinal haematoma have been presented. While some conditions contraindicate the use of neuraxial techniques, careful management of many of the types of impaired haemostasis can keep the balance of these two issues in favour of the practice of regional anaesthesia and pain control.
Conclusion
A cause du manque flagrant de données, il a toujours été difficile de faire un choix éclairé entre le risque d’hématome spinal et les bénéfices de l’anesthésie et de l’analgésie périopératoire régionale. Alors que des données pertinentes aux bénéfices de l’anesthésie régionale plaident en sa faveur, le nombre plus fréquent de patients chez qui on constate ou anticipe une anomalie de l’hémostase vient compliquer le problème. Les nombreuses déficiences de l’hémostase causées par des médicaments et la diathèse hémorragique, et nos perceptions de leur influence sur le risque d’hématome spinal ont été présentées. Alors que plusieurs déficiences de la coagulation contre-indiquent l’utilisation des techniques régionales centromédullaires, la gestion minutieuse de certaines autres anomalies de l’hémostase peut faire pencher la balance en faveur de la pratique des techniques régionales centromédullaires.
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Stafford-Smith, M. Impaired haemostasisd and regional anaesthesia. Can J Anaesth 43 (Suppl 1), R129–R141 (1996). https://doi.org/10.1007/BF03011675
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DOI: https://doi.org/10.1007/BF03011675