Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section D. Regional Anesthesia > Chapter 46. Neuraxial Anesthesia Daniel T. Warren, MD, and Spencer S. Liu, MD

Key Points

"1. A systematic and rational approach based on a thorough three-dimensional understanding of anatomy should be used when accessing the subarachnoid and epidural space.

2. Anesthetic doses, agents, and combinations of agents should be individualized so as to optimize neuraxial blockade for a given clinical setting.

3. Hypotension and bradycardia associated with neuraxial anesthesia should be identified early and treated aggressively in an attempt to prevent cardiovascular collapse and poor outcome.

4. Our understanding of potential neurotoxicity and the nature of transient neurologic symptoms (TNS) are continuing to evolve. However, there is growing consensus that TNS may not represent direct neural toxicity.

5. Evaluating the appropriateness of neuraxial procedures in patients receiving anticoagulant and antiplatelet medications is a challenge. Clinicians should be familiar with the recommendations presented by the American Society of Regional Anesthesia and Pain Management in the consensus statement addressing these issues.

6. When suspicion of spinal hematoma or abscess is credible, definitive diagnosis with appropriate imaging and prompt decompression within 4–6 hours of onset of neurologic symptoms is crucial to improve chances of recovery of function.

7. Developing an understanding of the nature..."