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Venous thromboembolism in children undergoing surgery:incidence,risk factors and related adverse events

World Journal of Pediatric Surgery 2020年第1期3卷 18-27页

作者： elbert johann mets Ryan Patrick McLynn Jonathan Newman Grauer Department of Orthopaedics and Rehabilitation Yale School of MedicineNew HavenConnecticutUSA Department of Orthopaedic Surgery University of Alabama at BirminghamBirminghamAlabamaUSA

background Although less common in adults,venous thromboembolism(VTE)in children is a highly morbid,preventable adverse *** VTE has been well studied among pediatric hospitalized and trauma patients,limited work has been done to examine postoperative VTE in children undergoing *** Using data from National Surgical Quality Improvement Project Pediatric database(NSQIP-P)from 2012 to 2016,a retrospective cohort analysis was performed to determine the incidence of,and risk factors for,VTE in children undergoing ***,the relationships between VTE and other postoperative adverse outcomes were *** Of 361384 pediatric surgical patients,378(0.10%)were identified as experiencing postoperative *** controlling for patient and surgical factors,we found that American Society of Anesthesiologists(ASA)class of II or greater,aged 16-18 years,non-elective surgery,general surgery(compared with several other surgical specialties),cardiothoracic surgery(compared with general surgery)and longer operative time were significantly associated with VTE in pediatric patients(p<0.001 for each comparison).Furthermore,a majority of adverse events were found to be associated with increased risk of subsequent VTE(p<0.001).Conclusion In a large pediatric surgical population,an incidence of postoperative VTE of 0.10%was *** patient and surgical factors,and perioperative adverse events were found to be associated with such VTE events.

关键词： surgery postoperative thrombo

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Management of Post-Dural Puncture Headache Using Autologous Epidural Blood Patch in a Patient with Acute Lymphoblastic Leukemia

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Open Journal of Anesthesiology 2017年第4期7卷 83-87页

作者： John Narron Mohamed Farrag elbert mets Saif Mahmoud Khaled Sedeek Hershey Medical Center Pennsylvania State University Hershey PA USA Cornell University Ithaca NY USA

We report a case of a patient in remission of acute lymphoblastic leukemia (ALL) with severe positional headaches that required an epidural blood patch (EBP) despite the higher risks of infection and introduction of blast cells to the epidural space. A 43-year-old male with a history of ALL presented with persistent positional headache after multiple intrathecal punctures. Despite initial improvement with medical treatment and bed rest, severe positional headache [consistent with post-dural puncture headache] constantly agonized the patient. EBP was performed after discussion of all of the medical teams involved. Following the procedure, the patient experienced immediate pain relief. EBP is very effective in the management of post-dural puncture headache (PDPH). Still there is risk of introducing infectious and/or malignant cells into the central nervous system. Alternatively, there are agents available that could be employed other than a patient’s own blood.

关键词： Acute Lymphoblastic Leukemia Intrathecal Punctures CSF Leakage Positional Headaches Epidural Blood Patch Autologous Blood

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