RT Book, Section
A1 Warren, Daniel T.
A1 Neal, Joseph M.
A1 Bernards, Christopher M.
A2 Longnecker, David E.
A2 Brown, David L.
A2 Newman, Mark F.
A2 Zapol, Warren M.
SR Print(0)
ID 56638559
T1 Chapter 47. Neuraxial Anesthesia
T2 Anesthesiology, 2e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-178513-6
LK accessanesthesiology.mhmedical.com/content.aspx?aid=56638559
RD 2024/04/19
AB A  systematic  and  rational  approach  based  on  a  thorough  3-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  and  the  nature  of  transient  neurologic  symptoms  (TNS)  are  continuing  to  evolve.  However,  there  is  growing  consensus  that  TNS  may  not  represent  direct  neural  toxicity.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  in  the  consensus  statement  addressing  these  issues.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.