Neuraxial anesthesia in the presence of clinical anticoagulation: what are our options for pediatric patients?

The use of local anesthesia combined with general anesthesia to provide effective perioperative analgesia continues to increase in the pediatric population. Although neurological complications resulting from peridural hemorrhage following placement of neuraxial blockade is extremely rare in the absence of co-morbid conditions, the consequences can be devastating. Therefore, caution should be exercised, especially in patients receiving antithrombotic or thrombolytic therapy. We present two patients who received unplanned anticoagulation therapy perioperatively following placement of an epidural catheter for postoperative analgesia. Potential concerns with anticoagulation therapy in patients with epidural catheters are discussed and suggestions for the care of such patients are presented.