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Serious Complications After Epidural Catheter Placement: Two Case Reports
- Source :
- Local and Regional Anesthesia
- Publication Year :
- 2021
- Publisher :
- Informa UK Limited, 2021.
-
Abstract
- Ronald Seidel,1 Marc Tietke,2 Oliver Heese,3 Uwe Walter4 1Asklepios Medical Center, Department of Anesthesiology and Intensive Care, Schwedt, Germany; 2Helios Medical Center, Department of Neuroradiology, Schwerin, Germany; 3Helios Medical Center, Department of Neurosurgery, Schwerin, Germany; 4University Medical Center Rostock, Department of Neurology, Rostock, GermanyCorrespondence: Ronald SeidelAsklepios Medical Center, Department of Anesthesiology and Intensive Care, Am Klinikum 1, Schwedt, 16303, GermanyTel +49 3332 534521Email ronald-seidel@t-online.deAbstract: Thoracic epidural analgesia (TEA) is a standard procedure in multimodal analgesia applied in major thoracic and abdominal surgeries. Two cases are presented with serious complications related to TEA. In both cases, earlier reaction of the treating physicians to patient-reported sensory symptoms could have prevented the complicated course. The first case was a 73-year-old patient with bronchial carcinoma who underwent right lower lobe resection. In this case, dabigatran 150 mg/d (indication: permanent atrial fibrillation) had been discontinued 72 hours before surgery, and enoxaparin 80 mg (every 12 hours) had been started 11 hours after surgery. An epidural hematoma developed postoperatively. Magnetic resonance imaging (MRI) was performed only after paraplegia had developed the next day. Unfortunately, delayed hematoma evacuation could not prevent persistent paraplegia in this case, which was complicated by hospital-acquired pneumonia with sepsis and acute renal failure. The second case was a 39-year-old patient with ulcerative colitis and an initially undetected malposition of the epidural catheter. Immediately after test bolus injection, the patient reported paresthesia and overall discomfort, which however could not be safely attributed to either the test dose or the already started general anesthesia. The patient could only be extubated after stopping the epidural infusion. Accidental re-start of epidural infusion led to coma, conjugate eye deviation, and respiratory arrest, necessitating re-intubation. Computed tomography (CT) ruled out intracerebral pathology and showed a catheter position centrally in the spinal canal. Fortunately, no neurological deficits were detected after catheter removal.Keywords: epidural analgesia, dabigatran, paraplegia, perioperative complications
- Subjects :
- Coma
medicine.medical_specialty
perioperative complications
medicine.diagnostic_test
business.industry
Respiratory arrest
epidural analgesia
Atrial fibrillation
Magnetic resonance imaging
medicine.disease
Surgery
Catheter
paraplegia
Anesthesiology and Pain Medicine
medicine.anatomical_structure
Epidural hematoma
medicine
Case Series
dabigatran
Spinal canal
Local and Regional Anesthesia
medicine.symptom
business
Paraplegia
Subjects
Details
- ISSN :
- 11787112
- Volume :
- 14
- Database :
- OpenAIRE
- Journal :
- Local and Regional Anesthesia
- Accession number :
- edsair.doi.dedup.....ae8227f4d0b4a3d5819f72903bb56c3d