Haematoma and abscess after neuraxial anaesthesia: a review of 647 cases.

Although rare, spinal haematoma and abscess after central neuraxial blocks may cause severe permanent neurological injury. Optimal treatment and outcome remain unclear. In order to identify possible predisposing patient characteristics and describe the ensuing clinical course, we searched Medline, Embase, and the Cochrane Library for reports of spinal haematomas and abscesses associated with central neuraxial blocks. Extracted data included patient characteristics, symptoms, treatment, and outcome. We analysed 409 reports, including 647 patients (387 patients with spinal haematoma and 260 patients with spinal abscess). Spinal haematoma and abscess occurred predominantly after epidural anaesthesia (58% and 83%, respectively). Neurological recovery was correlated with the severity of initial neurological deficit. When decompression of spinal haematoma was delayed for >12 h after clinical diagnosis, neurological outcome was worse compared with earlier decompression (odds ratio 4.5, 95% confidence interval 2.1-9.9, P<0.001, n=163). After spinal haematoma, 47% of published patients had full recovery, 28% had partial recovery, and in 25% no recovery was observed. Good outcome after conservative management was observed in patients with mild symptoms or with spontaneous recovery during the diagnostic and therapeutic workup. After spinal abscess, 68% of reported patients recovered fully, 21% showed partial recovery, and no recovery was reported in 11%. Persistent neurological symptoms after spinal haematoma and abscess are common and correlate with the severity of initial neurological deficit. Neurological outcome seems worse when decompressive surgery of haematoma is delayed. Notwithstanding the considerable risk of selection bias and publication bias, conservative management may be feasible in patients with mild symptoms or spontaneous recovery.

Analysis of prehospital perimortem caesarean deliveries performed by Helicopter Emergency Medical Services in the Netherlands and recommendations for the future.

BACKGROUND: Prehospital perimortem caesarean delivery (PCD) is a rarely performed procedure. In this study, we aimed to examine all PCDs performed by the four Helicopter Emergency Medical Services in the Netherlands; to describe the procedures, outcomes, complications, and compliance with the recommended guidelines; and to formulate recommendations. METHODS: We performed a population-based retrospective cohort study of all consecutive maternal out-of-hospital cardiac arrests that underwent PCD in the prehospital setting between May 1995 and December 2019. Registered data included patient demographics, operator background, advanced life support interventions, and timelines. Resuscitation performance was evaluated according to the 2015 European Resuscitation Guidelines. RESULTS: Seven patients underwent a prehospital PCD. Three mothers died on the scene, while four were transported to a hospital but died in the hospital. Seven neonates were born by PCD. One neonate died on the scene and six were transported to a hospital. Three neonates were eventually discharged from the hospital. Among the three surviving neonates, the periods from dispatch to start of PCD were 13, 14, and 21 min. CONCLUSIONS: There was a low incidence of maternal perimortem caesarean deliveries in The Netherlands. Only some neonates survived after PCD. It is recommended that PCD be performed as quickly as possible. Due to the delay, the mother has a far lower chance of survival than the neonate. In fatal cases, autopsy is strongly recommended.

Intoxication with therapeutic and illicit drug substances and hospital admission to a Dutch university hospital.

BACKGROUND: This article describes the retrospective analysis of the patients who presented with a drug-related intoxication to the emergency department of the Erasmus Medical Centre in 2000. METHODS: Data were collected from the emergency department's electronic database and the medical charts of the patients. RESULTS: A total of 243 patients were seen with a drug-related intoxication caused by ingestion of one or more medical substances, drugs of abuse (DOA) or combinations with alcohol. Mono-intoxication occurred in 58% of the patients, predominantly caused by DOA (56 patients), analgesics (17 patients) or benzodiazepines (14 patients). Benzodiazepines (55 patients), analgesics (42 patients), alcohol (42 patients), DOA (40 patients) and antidepressants (23 patients) were predominant in combined intoxications. More than half of the patients (142) were discharged after being treated in the emergency department and 80 patients were admitted to the wards. Eighteen patients were admitted elsewhere and three patients were lost to follow-up. Eventually, 70 patients were discharged after having been admitted, five patients were admitted to other institutions, two patients died and three patients were lost to follow-up. CONCLUSIONS: DOA, benzodiazepines, analgesics, alcohol and antidepressants accounted for approximately 65% of the drug-related intoxications in 2000 and in a third of the presenting patients, toxicity was such that admission to the wards was warranted.