Incidence of epidural haematoma and neurological injury in cardiovascular patients with epidural analgesia/anaesthesia: systematic review and meta-analysis

BACKGROUND: Epidural anaesthesia is used extensively for cardiothoracic and vascular surgery in some centres, but not in others, with argument over the safety of the technique in patients who are usually extensively anticoagulated before, during, and after surgery. The principle concern is bleeding in the epidural space, leading to transient or persistent neurological problems. METHODS: We performed an extensive systematic review to find published cohorts of use of epidural catheters during vascular, cardiac, and thoracic surgery, using electronic searching, hand searching, and reference lists of retrieved articles. RESULTS: Twelve studies included 14,105 patients, of whom 5,026 (36%) had vascular surgery, 4,971 (35%) cardiac surgery, and 4,108 (29%) thoracic surgery. There were no cases of epidural haematoma, giving maximum risks following epidural anaesthesia in cardiac, thoracic, and vascular surgery of 1 in 1,700, 1 in 1,400 and 1 in 1,700 respectively. In all these surgery types combined the maximum expected rate would be 1 in 4,700. In all these patients combined there were eight cases of transient neurological injury, a rate of 1 in 1,700 (95% confidence interval 1 in 3,300 to 1 in 850). There were no cases of persistent neurological injury (maximum expected rate 1 in 4,600). CONCLUSION: These estimates for cardiothoracic epidural anaesthesia should be the worst case. Limitations are inadequate denominators for different types of surgery in anticoagulated cardiothoracic or vascular patients more at risk of bleeding

Upaya Meningkatkan Prestasibelajaripa-fisika Melalui Penerapan Strategi Pembelajaran Inkuiriterbimbing Pada Siswa Kelas Vhi Di Mtsn

This research is aim to know : 1) to implementation of guided inquiry learning strategy for for the increasing of students achievement's IPA-Fisika, 2) to increasing of students achievement's IPA-Fisika throug implementation of guided inquiry learning strategy. The research subject of this class action research is all of the students of who sit on class VIII STsN 1 Ngemplak Boyolali, there are consist of 36 students. The data is collected with the technique test and observation. The technique test is to know the student achievement while the observation is to know the students attention, response, and activeness. The data is analyzed by utilization student comparative description analysis and T-test. The result of this research are: 1) implementation of guided inquiry learning strategy for for the increasing of students achievement's IPA-Fisika by step: a) phase of presentation of internal issue form of spread sheet student, b) discussion of guidance, c) activity of descovery, d) final discussion, e) to make the conclusion and follow-up..2) improvement of achievement learn of IPA-Fisika at interest elementary wake up the side space arch to pass guided inquiry learning strategy to show at improvement attainment of achievement learn the student at cycle I and H at cycle I from 36 student obtain to sum up value counted 217,5 average value 6,024 with standard deviasi 1,003. at cycle II: get to sum up value counted 252, average value 7,00 with standard deviation 0,802. From result obtain of achievement learn at cycle I and n analysis by using test t. From result calculation the show that to 4,933, ttabie= 1,67 at level signifikansi 0,05 with db=70. So that inferential that applying guided inquiry learning strategy can to improve achievement learn of IPA-Fisika