Tags

Type your tag names separated by a space and hit enter

The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia.
Anesth Analg. 2021 06 01; 132(6):1531-1544.A&A

Abstract

Because up to 12% of obstetric patients meet criteria for the diagnosis of thrombocytopenia in pregnancy, it is not infrequent that the anesthesiologist must decide whether to proceed with a neuraxial procedure in an affected patient. Given the potential morbidity associated with general anesthesia for cesarean delivery, thoughtful consideration of which patients with thrombocytopenia are likely to have an increased risk of spinal epidural hematoma with neuraxial procedures, and when these risks outweigh the relative benefits is important to consider and to inform shared decision making with patients. Because there are substantial risks associated with withholding a neuraxial analgesic/anesthetic procedure in obstetric patients, every effort should be made to perform a bleeding history assessment and determine the thrombocytopenia etiology before admission for delivery. Whereas multiple other professional societies (obstetric, interventional pain, and hematologic) have published guidelines addressing platelet thresholds for safe neuraxial procedures, the US anesthesia professional societies have been silent on this topic. Despite a paucity of high-quality data, there are now meta-analyses that provide better estimations of risks. An interdisciplinary taskforce was convened to unite the relevant professional societies, synthesize the data, and provide a practical decision algorithm to help inform risk-benefit discussions and shared decision making with patients. Through a systematic review and modified Delphi process, the taskforce concluded that the best available evidence indicates the risk of spinal epidural hematoma associated with a platelet count ≥70,000 × 106/L is likely to be very low in obstetric patients with thrombocytopenia secondary to gestational thrombocytopenia, immune thrombocytopenia (ITP), and hypertensive disorders of pregnancy in the absence of other risk factors. Ultimately, the decision of whether to proceed with a neuraxial procedure in an obstetric patient with thrombocytopenia occurs within a clinical context. Potentially relevant factors include, but are not limited to, patient comorbidities, obstetric risk factors, airway examination, available airway equipment, risk of general anesthesia, and patient preference.

Authors+Show Affiliations

From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.Department of Medicine, University of Washington School of Medicine, Seattle, Washington.Department of Medicine, Medical College of Wisconsin and Versiti, Milwaukee, Wisconsin.Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, New York, New York.Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, Liaison for the American College of Obstetricians and Gynecologists.Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.Taubman Health Sciences Library, University of Michigan Medical School, Ann Arbor, Michigan.Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.Department of Medicine, University of Florida, Gainesville, Florida.Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.Department of Medicine, University of Washington School of Medicine, Seattle, Washington.Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York.Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

33861047

Citation

Bauer, Melissa E., et al. "The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement On Neuraxial Procedures in Obstetric Patients With Thrombocytopenia." Anesthesia and Analgesia, vol. 132, no. 6, 2021, pp. 1531-1544.
Bauer ME, Arendt K, Beilin Y, et al. The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia. Anesth Analg. 2021;132(6):1531-1544.
Bauer, M. E., Arendt, K., Beilin, Y., Gernsheimer, T., Perez Botero, J., James, A. H., Yaghmour, E., Toledano, R. D., Turrentine, M., Houle, T., MacEachern, M., Madden, H., Rajasekhar, A., Segal, S., Wu, C., Cooper, J. P., Landau, R., & Leffert, L. (2021). The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia. Anesthesia and Analgesia, 132(6), 1531-1544. https://doi.org/10.1213/ANE.0000000000005355
Bauer ME, et al. The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement On Neuraxial Procedures in Obstetric Patients With Thrombocytopenia. Anesth Analg. 2021 06 1;132(6):1531-1544. PubMed PMID: 33861047.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia. AU - Bauer,Melissa E, AU - Arendt,Katherine, AU - Beilin,Yaakov, AU - Gernsheimer,Terry, AU - Perez Botero,Juliana, AU - James,Andra H, AU - Yaghmour,Edward, AU - Toledano,Roulhac D, AU - Turrentine,Mark, AU - Houle,Timothy, AU - MacEachern,Mark, AU - Madden,Hannah, AU - Rajasekhar,Anita, AU - Segal,Scott, AU - Wu,Christopher, AU - Cooper,Jason P, AU - Landau,Ruth, AU - Leffert,Lisa, PY - 2021/4/17/pubmed PY - 2021/7/28/medline PY - 2021/4/16/entrez SP - 1531 EP - 1544 JF - Anesthesia and analgesia JO - Anesth Analg VL - 132 IS - 6 N2 - Because up to 12% of obstetric patients meet criteria for the diagnosis of thrombocytopenia in pregnancy, it is not infrequent that the anesthesiologist must decide whether to proceed with a neuraxial procedure in an affected patient. Given the potential morbidity associated with general anesthesia for cesarean delivery, thoughtful consideration of which patients with thrombocytopenia are likely to have an increased risk of spinal epidural hematoma with neuraxial procedures, and when these risks outweigh the relative benefits is important to consider and to inform shared decision making with patients. Because there are substantial risks associated with withholding a neuraxial analgesic/anesthetic procedure in obstetric patients, every effort should be made to perform a bleeding history assessment and determine the thrombocytopenia etiology before admission for delivery. Whereas multiple other professional societies (obstetric, interventional pain, and hematologic) have published guidelines addressing platelet thresholds for safe neuraxial procedures, the US anesthesia professional societies have been silent on this topic. Despite a paucity of high-quality data, there are now meta-analyses that provide better estimations of risks. An interdisciplinary taskforce was convened to unite the relevant professional societies, synthesize the data, and provide a practical decision algorithm to help inform risk-benefit discussions and shared decision making with patients. Through a systematic review and modified Delphi process, the taskforce concluded that the best available evidence indicates the risk of spinal epidural hematoma associated with a platelet count ≥70,000 × 106/L is likely to be very low in obstetric patients with thrombocytopenia secondary to gestational thrombocytopenia, immune thrombocytopenia (ITP), and hypertensive disorders of pregnancy in the absence of other risk factors. Ultimately, the decision of whether to proceed with a neuraxial procedure in an obstetric patient with thrombocytopenia occurs within a clinical context. Potentially relevant factors include, but are not limited to, patient comorbidities, obstetric risk factors, airway examination, available airway equipment, risk of general anesthesia, and patient preference. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/33861047/The_Society_for_Obstetric_Anesthesia_and_Perinatology_Interdisciplinary_Consensus_Statement_on_Neuraxial_Procedures_in_Obstetric_Patients_With_Thrombocytopenia. L2 - https://doi.org/10.1213/ANE.0000000000005355 DB - PRIME DP - Unbound Medicine ER -