TY - CHAP M1 - Book, Section TI - Neuraxial Anesthesia A1 - Warren, Daniel T. A1 - Nelson, Kenneth E A1 - Neal, Joseph M. A2 - Longnecker, David E. A2 - Mackey, Sean C. A2 - Newman, Mark F. A2 - Sandberg, Warren S. A2 - Zapol, Warren M. Y1 - 2017 N1 - T2 - Anesthesiology, 3e AB - KEY POINTSA systematic and rational approach based on a thorough three-dimensional understanding of anatomy should be used when accessing the subarachnoid or epidural space.Anesthetic doses, agents, and combinations of agents should be individualized to optimize neuraxial blockade for a given clinical setting.Hypotension and bradycardia associated with neuraxial anesthesia should be identified early and treated aggressively to minimize development of cardiovascular collapse and poor outcome.Our understanding of potential neurotoxicity of local anesthetics and the nature of transient neurologic symptoms (TNS) is continuing to evolve. However, there is growing consensus that TNS may not represent direct neural toxicity. The incidence of TNS is very low for spinal 2-chloroprocaine.Evaluating the appropriateness of neuraxial procedures in patients receiving anticoagulant and antiplatelet medications is a challenge. Clinicians should be familiar with the recommendations presented by the American Society of Regional Anesthesia and Pain Medicine (ASRA) in the consensus statements (updated for regional anesthesia and separate publication for interventional pain procedures) addressing these issues, which are now readily available in the ASRA mobile device apps.When suspicion of spinal hematoma or abscess is credible, definitive diagnosis with appropriate imaging and prompt surgical decompression within 4 to 8 hours of onset of neurologic symptoms is crucial to improve chances of recovery of function.Developing an understanding of the nature of combined spinal-epidural anesthesia and facility with its techniques can expand a clinician’s armamentarium to provide neuraxial anesthesia and optimize patient care. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1144119692 ER -