ABSTRACT
Epidural hematoma after epidural catheterization is very rare but one of serious complications. Although true incidence and origin is unknown yet, coagulopathies and anticoagulant therapy are predominant risk factors. Other risk factors are NSAIDs treatment and ankylosing spondylitis. We experienced a case of epidural hematoma without any risk factors after epidural catheterization for postoperative pain control. We performed epidural catheterization before operation and postoperatively the patient received continuous epidural infusion for postoperative pain control. On the first operative day, the patient was noted to have developed complete paraplegia and hypoesthesia below L1 and anesthesia below L2 level. Immediately after noting we performed TL-spine MRI and epidural hematoma at T10 level was diagnosed and treated by decompressive laminectomy. But she has not fully recovered yet.
Subject(s)
Humans , Anesthesia , Anti-Inflammatory Agents, Non-Steroidal , Catheterization , Catheters , Hematoma , Hypesthesia , Incidence , Laminectomy , Magnetic Resonance Imaging , Pain, Postoperative , Paraplegia , Risk Factors , Spondylitis, AnkylosingABSTRACT
A 35-year-old male patient underwent surgery to clip a giant middle cerebral artery aneurysm with closed-chest cardiopulmonary bypass using femorofemoral bypass. Deep hypothermia (18-20 degrees C), low-flow cardiopulmonary bypass and propofol infusion (6-8 mg/kg/h) were used under general anesthesia. Venous drainage via femoral vein was suffcient and ventricular distension was not observed on transesophageal echocardiography. On Electroencephalogram, burst suppression pattern was presented due to deep hypothermia and propofol infusion. Instead of deep hypothermic circulatory arrest perfusion flow was maintained at low-flow (33 ml/kg/min) during aneurysmal clipping. Postoperatively, the patient was transferred to intensive care unit and discharged without neurological deficit.
Subject(s)
Adult , Humans , Male , Anesthesia, General , Aneurysm , Cardiopulmonary Bypass , Circulatory Arrest, Deep Hypothermia Induced , Drainage , Echocardiography, Transesophageal , Electroencephalography , Femoral Vein , Hypothermia , Intensive Care Units , Intracranial Aneurysm , Perfusion , PropofolABSTRACT
BACKGROUND: Near infrared spectroscopy (NIRS) to monitor regional cerebral oxygen saturation (rSO2) is a noninvasive and simple modal ity in clinical use. The ability of rSO2 as an index of cerebral oxygenation has been well demonstrated. However, the reliability of rSO2 to reflect the changes of cerebral vascular reactivity in the changes of arterial partial pressure of CO2 (PaCO2) has not been established. The aim of this study was to verify the reliability of rSO2 to measure the CO2 reactivity of cerebral vasculatures. METHODS: Twenty healthy adult patients undergoing general anesthesia were enrolled in this study. Anesthesia was induced with propofol and maintained with desflurane/N2O. Respiration was mechanically controlled. The radial artery and jugular bulb were cannulated. The sensor of the NIRS was attached to the ipsilateral forehead. During normocapnia (PaCO2 40 +/- 1.3 mmHg) and hypocapnia (PaCO2 30 +/- 2.4 mmHg), blood was obtained from the radial artery and jugular bulb and analyzed. rSO2 was compared with fSO2 (estimated field oxygen satuation), and the gold standard of tissue oxygen saturation. fSO2 was calculated from the following equation: fSO2 = 0.75 SjO2 + 0.25 SaO2. RESULTS: rSO2 significantly correlated with fSO2 (P = 0.000, r2 = 0.56). A bias of - 5.8% with a precision 12.94% was found. CONCLUSIONS: We concluded that rSO2 can be a reliable predictor to measure CO2 reactivity of cerebral vasculatures during normocapnia and hypocapnia.