considered a low platelet count from the perspective of epidural catheter
placement and why is there controversy regarding choosing a lowest ‚Äúsafe‚ÄĚ
An epidural hematoma is a catastrophic
complication, which can lead to permanent paralysis. It is, therefore, pru-dent
to practice in a conservative manner and not place an epidural anesthetic if
the patient is at any risk of developing this complication. Cousins and Bromage
recommended in 1988 that one should not perform an epidural anesthetic if the
platelet count is less than 100,000 mm‚ąí3. Recently, how-ever, this recommendation has been widely disputed.
Thrombocytopenia is the most common hematologic
disorder during pregnancy. Choosing an absolute platelet count below which it
is considered too dangerous to place a neuraxial anesthetic may dictate the use
of general anes-thesia, a riskier technique in the parturient. Hawkins et al.
(1997) reviewed pregnancy-related deaths in the United States between 1985 and
1990 and found that the fatality rate for a parturient administered general
anesthesia for cesarean section was 32 deaths per million and for neuraxial
anesthesia was only 2 deaths per million.
Refraining from administering a neuraxial
anesthetic during the labor and delivery process based on a low platelet count
commits the patient, at least, to a painful labor. It is possible that later in
the course of labor the woman may require a cesarean delivery, perhaps
emergently. The anesthesiologist in that situation may then be forced to
administer an anesthetic under less than optimal conditions.