British journal of anaesthesia
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Case Reports
Epidural haematoma after a combined spinal-epidural anaesthetic in a patient treated with clopidogrel and dalteparin.
We report a case of a spinal-epidural haematoma occurring in a patient after a combined spinal-epidural anaesthetic. She had been taking clopidogrel and had received perioperative dalteparin for thromboprophylaxis. Despite adhering to standard guidelines concerning administration of low molecular weight heparin perioperatively and stopping the clopidogrel 7 days before the anaesthetic, the patient developed an epidural haematoma.
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Although N(2)O has been widely used as an anaesthetic adjuvant its effect on electroencephalographic (EEG) activity is poorly understood because it is usually studied in the presence of additional anaesthetics, including inhaled anaesthetics. We examined the EEG effects of N(2)O in rats using a hyperbaric chamber that permitted N(2)O to be the sole anaesthetic. ⋯ These data indicate that N(2)O at peri-MAC partial pressures prevents EEG activation resulting from noxious electrical stimulation. Unlike the situation with isoflurane, stimulus-evoked EEG activation did not occur at peri-MAC anaesthetic concentrations, suggesting that N(2)O potently blocked ascending nociceptive transmission.