Detailed explanation of the contraindications for intra-spinal anesthesia! People with coagulation dysfunction need to avoid
Intraspinal anesthesia (including subarachnoid anesthesia and epidural anesthesia) is a commonly used clinical anesthesia method, but its applicability is limited by a variety of factors. This article will analyze the contraindications of intra-spinal anesthesia in detail in light of the hot medical topics across the network for the past 10 days, focus on the risks of coagulation dysfunction, and provide structured data for clinical reference.
1. Classification of absolute contraindications and relative contraindications
| Taboo Types | Specific content | Risk level |
|---|---|---|
| Absolute contraindications | Patient rejection, infection at the puncture site, increased intracranial pressure, severe coagulation dysfunction | No implementation |
| Relative contraindications | Mild coagulation abnormalities, spinal deformities, hypovolemia, neurological diseases | Risk-benefit ratio needs to be evaluated |
2. Specific risk indicators for coagulation dysfunction
Recent hot medical cases show that unidentified coagulation abnormalities are the main cause of intra-spinal hematoma. Here are the key laboratory indicator thresholds:
| Testing items | Security threshold | Hazard threshold |
|---|---|---|
| Platelet count | >100×10⁹/L | <50×10⁹/L |
| INR | <1.4 | >1.5 |
| APTT | Normal range | Extended >1.5 times |
3. Anticoagulant medication use time window
Based on the latest clinical guidelines, the discontinuation time requirements for common anticoagulants:
| Drug Type | Preoperative medication discontinuation time | Postoperative recovery time |
|---|---|---|
| Warfarin | 5 days | After 24 hours |
| Heparin (treatment amount) | 4-6 hours | After 1 hour |
| New oral anticoagulant | 48-72 hours | After 6 hours |
4. Things to note for special groups
1.Pregnant women: The incidence of thrombocytopenia is high, and the platelets need to be tested repeatedly
2.Elderly patients: The decrease in creatinine clearance affects anticoagulant metabolism
3.Patients with liver disease: The synthesis of coagulation factors is reduced, and INR is abnormal
5. Controversial hot topic discussion
Recent academic controversy focuses on:
• Is intra-spinal anesthesia possible if platelet count 50-100×10⁹/L
• Choice of anticoagulant reversal strategies in patients with emergency surgery
• Optimal interval for monitoring neurological function after intra-spinal anesthesia
6. Clinical decision-making suggestions
1. Improve preoperative coagulation function screening (including platelets, INR, APTT)
2. Inquiry in detail about the history of anticoagulant use
3. Establish a multidisciplinary consultation mechanism to deal with complex cases
4. Closely monitor changes in neurological function after surgery
Intra-spinal anesthesia is used in patients with coagulation dysfunction and requires extreme caution. Reasonable preoperative evaluation and standardized perioperative management can significantly reduce the risk of complications. It is recommended that clinicians continue to pay attention to the latest guidelines and formulate an anesthesia plan based on the individualized characteristics of patients.
check the details
check the details
en
