Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesia100 microgram increments up to 1 mg max.This works in 60 s and the patient may need aflumazenil infusion.CVADisorientationRequires further medical examination.AnticoagulationThe following guidelines are in accordance with international practiceand should be followed in patients on anticoagulant medication andwho require insertion and removal of epidural catheters.If a patient has been on low molecular weight heparin orunfractionated heparin for more than 48 hours it may be necessary todo a platelet count prior to epidural insertion / removal.The following regimes apply only to those patients on prophylacticanticoagulation.Patients on subcutaneous unfractionated heparinInsertion and removal should be greater than 4 hours after and notless than 2 hours before the next dose. In patients on 8-hourlyheparin the above conditions mean that the dose after the proceduremay have to be delayed.Patients on low-molecular weight heparin e.g. enoxaparin (Clexane)Once-daily dosing with administration in the evening is stronglyrecommended. Insertion and removal should be greater than 12hours after and not less than 2 hours before next dose.Patients on warfarinThe catheter may be removed within 12 hours of first dose. In allother situations; stop warfarin, measure INR and defer removal ifpossible until INR is less than 1.5.138 Anaesthetists Handbook January 2010