Paraplegia caused by spinal haemorrhage is a very rare but disastrous complication of spinal or epidural insertion. The risk in uncomplicated surgical and obstetric patients is outlined. Bleeding disorders in pregnant patients may prevent the use of major regional anaesthesia. Factors which influence the choice of anaesthetic technique for patients with pregnancy-induced hypertension, von Willebrand's disease, and anticoagulation therapy, are discussed.
GreensiteF.S., KatzJ.Spinal subdural hematoma associated with attempted epidural anesthesia and subsequent continuous spinal anesthesia. Anesth Analg1980; 59: 72–3.
20.
BallinN.C.Paraplegia following epidural analgesia. Anaesthesia1981; 36: 952–3.
21.
WulfH., MaierC., StrieplingE.Epidural hematoma following epidural catheter anesthesia in thrombocytopenia. Reg Anesth1988; 11, 1: 26–7.
22.
GustafssonH., RutbergH., BengtssonM.Spinal haematoma following epidural analgesia. Anaesthesia1988; 43: 220–2.
23.
NewrickP., ReadD.Subdural haematoma as a complication of spinal anaesthetic. Br Med J Clin Res1982 Jul 31; 285, 6338: 341–2.
24.
VerniquetA.J.W.Vessel puncture with epidural catheters. Experience in obstetric patients. Anaesthesia1980; 35: 660–2.
25.
OwensE.L., KastenG.W., HesselE.A.Spinal subarachnoid hematoma after lumbar puncture and heparinisation: a case report, review of the literature and discussion of anesthetic implications. Anesth Analg1986; 65: 1201–7.
26.
BarkerG.L.Spinal subdural haematoma following spinal anaesthesia. Anaesthesia1988; 43: 664–5.
27.
BonicaJ.J., BackupP.H., AndersonC.E., HadfieldD., CreppsW.F., MonkB.F.Peridural block: analysis of 3637 cases and a review. Anesthesiology1957; 18: 723.
28.
ElsenS.M., RosenN., WinesankerH.. The routine use of lumbar epidural anaesthesia in obstetrics: a clinical review of 9532 cases. Canad Anaesth Soc J1960; 7: 280–9.
29.
LundP.C.Peridural anesthesia; a review of 10 000 administrations. Acta Anaesth Scand1962; 6: 143–59.
30.
MooreD.C., BridenbaughL.D., BagdiP.A., BridenbaughP.O., StanderH.The present status of spinal (subarachnoid) and epidural (peridural) block: a comparison of two techniques. Anesth Analg1968; 47: 40–9.
MooreD.C., BridenbaughL.D.Spinal (subarachnoid) block: a review of 11 574 cases. JAMA1966; 195: 907–12.
38.
PhillipsO.C., EbnerH., NelsonA.T., BlackM.H.Neurologic complications following spinal anesthesia with lidocaine: a prospective review of 10 440 cases. Anesthesiology1969; 30: 284–9.
WildsmithJ.A.W.Spinal subdural haematoma after spinal anaesthesia (letter). Anaesthesia1989; 44: 526.
44.
RuffR.L., DoughertyJ.H.Complications of lumbar puncture followed by anticoagulation. Stroke1981; 12: 879–81.
45.
BremS.S., HaflerD.A., Van UitertR.L., RuffR.L., ReichertW.H.Spinal subarachnoid hematoma: a hazard of lumbar puncture resulting in reversible paraplegia. N Engl J Med1981; 304: 1020–1.
46.
LunnJ.K., DannemillerF.J., StanleyT.H.Cardiovascular responses to clamping of the aorta during epidural and general anesthesia. Anesth Analg1979; 58: 372–6.
47.
CunninghamF.O., EganJ.M., InaharaT.Continuous epidural anesthesia in abdominal vascular surgery: a review of 100 consecutive cases. Am J Surg1980 May; 139, 5: 624–7.
48.
MathewsE.T., AbramsL.D.Intrathecal morphine in open heart surgery. Lancet1980; Sept 6: 543.
49.
RaoT.L., El-EtrA.A.Anticoagulation following placement of epidural and subarachnoid catheters: an evaluation of neurologic sequelae. Anesthesiology1981; 55, 6: 618–20.
50.
OdoomJ.A., SihI.L.Epidural analgesic and anticoagulant therapy: experience with one thousand cases of continuous epidurals. Anaesthesia1983; 38: 254–9.
51.
OdoomJ.A.Epidural analgesia and anticoagulant therapy. (Letter) Anaesthesia1983; 38: 602–3.
52.
BaronH.C., La RajaR.D., RossiG., AtkinsonD.Continuous epidural analgesia in the heparinised vascular surgical patient: a retrospective review of 912 patients. J Vasc Surgery1987; 6: 144–6.
53.
VanstrumG.S., BjornsonK.M., IlkoR.Postoperative effects of intrathecal morphine in coronary artery surgery. Anesth Analg1988; 67: 261–7.
54.
AllemannB.H., GerberH., GruberU.F.Ruchkenmarksnahe Anaesthesie und subkutan verabreichtes low-dose Heparin-Dihydergot zur Thromboembolieprophylaxe. (English title: Perispinal anaesthesia and subcutaneous administration of low-dose heparin-dihydergot for prevention of thromboembolism). Anaesthetist1983; 32: 80–3.
LevineM.N., HirshJ.Clinical use of low molecular weight heparins and heparinoids. Semin Thromb Hemostasis1988; 14: 116–125.
60.
LambertD.H.Complications of spinal anesthesia. International Anesthesiol Clin1989; 27: 51–55.
61.
HahleyS.P., BevanJ., CockbillS.R., HeptinstallS.Differential inhibition by low-dose aspirin of human venous prostacyclin synthesis and platelet thromboxane synthesis. Lancet1981; i: 969–71.
62.
TaivainenT., HillerA., RosenbergP.H., NeuvonenP.The effect of continuous intravenous indomethacin infusion on bleeding time and postoperative pain in patients undergoing emergency surgery of the lower extremities. Acta Anaesthesiol Scand1989; 33: 58–60.
63.
LetskyE.A.Coagulation problems during pregnancy: Current Reviews in Obstetrics and Gynaecology. Churchill Livingstone1985; Vol 10.
64.
LetskyE.A.Coagulation defects. In: De Swiet M. Medical disorders in obstetric practice, 2nd Ed, Oxford. Blackwell1989; 104–165.
65.
KeltonJ.G., CruickshankM.Hematologic disorders of pregnancy. In: BurrowG.N., FerrisT.F. eds. Medical complications during pregnancy.WB Saunders Co, 1988.
66.
BonnarJ.Haemostasis and coagulation disorders in pregnancy. In: BloomAL., ThomasD.P. eds. Haemostasis and thrombosis.Edinburgh Churchill Livingstone1981; 454–471.
67.
BrownM.A.Pregnancy-induced hypertension: current concepts. Anaesth Intensive Care; 17: 185–97.
68.
BurrowsR.F., KeltonJ.G.Incidentally detected thrombocytopenia in healthy mothers and their infants. N Engl J Med1988; 319: 142–5.
69.
RedmanC.W.G., BonnarJ., BellinC.Early platelet consumption in pre-eclampsia. BMJ1978; 1: 467–9.
70.
GilesC., InglisT.C.M.Thrombocytopenia and macrothrombocytosis in gestational hypertension. Br J Obstet Gynaecol1981; 88: 1115.
RakocziT., TallianF., BagdanyS., GatiI.Platelet lifespan in normal pregnancy and pre-eclampsia as determined by a nonradioisotope technique. Thrombosis Research1979; 15: 553–6.
73.
WhighamK.A.E., HowieP.W., DrummondA.H., PrenticeC.R.M.Abnormal platelet function in preeclampsia. Br J Obstet Gynaecol1978; 85: 28–32.
74.
KeltonJ.G., HunterD.J.S., NeameP.B.A platelet function defect in pre-eclampsia. Obstet Gynecol1985; 65: 1: 107–109.
75.
Hew-WingP., RolbinS.H., HewE., AmatoD.Epidural anaesthesia and thrombocytopenia. Anaesthesia1989; 44: 775–7.
76.
SmedstadK.G.Controversies in obstetric anaesthesia. Canad J Anaesth1989; 36: S20–25.
77.
ElmsM.J., BunceI.H., BundesonP.G.. Measurement of cross-linked fibrin degradation products: an immunoassay using monoclonal antibodies. Thromb Haemost1983; 50: 591–4.
78.
GreenbergC.S., DevineD.V., McCraeC.E.Measurement of plasma fibrin D-dimer levels with the use of a monoclonal antibody coupled to latex beads. Am J Clin Pathol1987; 87: 94–100.
79.
MombaertsP., BallegeerV., DeclerckP., Van AsscheF.A.Fibrinolytic response to venous occlusion and fibrin fragment D-dimer and fibrinonectin levels in normal and complicated pregnancy (Abstr). Thromb Haemostas1987; 58: Ab344.
80.
TrofatterK.F., HowellM.L., GreenbergC.S., HageM.L.Use of the fibrin D-dimer in screening for coagulation abnormalities in pre-eclampsia. Obstet Gynecol1989; 73: 3: 435–9.
81.
Anonymous.DDAVP in haemophilia and von Willebrand's disease. Lancet1983; Oct 1: 774–5.
82.
PlumleyM.H.DDAVP and anaesthesia. Anaesthesia1988; 43: 898.
83.
BennettG.G., OakleyC.M.Pregnancy in a patient with mitral valve prosthesis. Lancet 1968: 1; 616–619.
