title: Neuraxial anesthesia and timing of heparin administration in patients undergoing surgery for congenital heart disease using cardiopulmonary bypass.
abstract: OBJECTIVE
  The goal of this review was to add to the existing literature documenting the safety of performing neuraxial techniques in patients who are subsequently fully heparinized, with particular emphasis on the timing of heparin administration. This will help improve risk estimation and possibly lead to a more widespread use of neuraxial anesthesia in patients undergoing cardiac surgery.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Single tertiary-care university hospital.
  
  
  METHODS
  All patients undergoing surgery for congenital heart diseases during a 5-year period.
  
  
  METHODS
  The medical records of all patients undergoing surgery for congenital heart diseases during a 5-year period were reviewed for any complications related to the use of neuraxial anesthesia. Furthermore, the interval from neuraxial anesthesia to heparinization for cardiopulmonary bypass was examined.
  
  
  RESULTS
  In total, 714 patients were identified who had neuraxial anesthesia administered before full heparinization for cardiopulmonary bypass. No cases of symptomatic spinal or epidural hematomas occurred. Further analysis showed that the interval from neuraxial anesthesia to full heparinization was <1 hour in 466 patients.
  
  
  CONCLUSIONS
  No complications related to neuraxial anesthesia were found in a series of 714 patients undergoing surgery for congenital heart disease using cardiopulmonary bypass, including 466 patients in whom the interval from neuraxial anesthesia to full heparinization was <1 hour.
authors.affiliation: Department of Anesthesiology, The Mount Sinai School of Medicine, New York, NY, USA. menachem.weiner@mountsinai.org
authors.forename: Menachem M
authors.initials: MM
authors.lastname: Weiner
authors.forename: Meg A
authors.initials: MA
authors.lastname: Rosenblatt
authors.forename: Alexander J C
authors.initials: AJ
authors.lastname: Mittnacht
mesh_terms: D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000925:Anticoagulants / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D006493:Heparin