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EPIDURAL CATHETER MANAGEMENT AND EXIT STRATEGY IN PATIENT WITH SEVERE THROMBOCYTOPENIA AND COAGULOPATHY AFTER EPIDURAL CATHETER INSERTION: A CASE REPORT
Author(s): ,
Nur Hafiizhoh, A.H.*
Affiliations:
KK Women's and Children's Hospital, Paediatric Anaesthesia Department, Singapore, Singapore
Ali, A.
Affiliations:
KK Women's and Children's Hospital, Paediatric Anaesthesia Department, Singapore, Singapore
ESRA Academy. Nur Hafiizhoh A. Sep 16, 2017; 196152; esra7-0204
Abd Hamid Nur Hafiizhoh
Abd Hamid Nur Hafiizhoh
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Abstract
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Background and Aims:

Extensive guidelines are published pertaining epidural catheter insertion, maintenance and catheter removal amongst patients receiving anticoagulant, antiplatelet and herbal medicine specifically aimed to modify the coagulation and platelet functions. Very limited recourses and guidelines in the management of epidural and epidural catheter removal are available addressing patient who developed thrombocytopenia and coagulopathy after insertion of epidural catheter. Furthermore, management of this scenario in pediatric population faces further challenges. We report a case on the management of epidural and epidural catheter exit strategy in 19 months old boy who had normal preoperative platelet counts and coagulation profile, went on to develop severe thrombocytopenia and coagulopathy following nephron-sparing Wilms tumour resection. The surgery was unduly complicated and prolonged due to unexpected difficulty encountered during the procedure, resulting in patient developing severe thrombocytopenia and coagulopathy.

Methods:

After extensive literature reviews and meticulous management of this case, we have formulated a step-wise approach on the management of epidural and epidural catheter exit strategy in patient with unexpected postoperative thrombocytopenia and coagulopathy as shown in Figure 1 and Figure 2.

Results:



Conclusions:

We propose these strategies to be used as a guideline in managing pathologically induced thrombocytopenia and/or coagulopathy in both pediatric and adult patients.

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