ABSTRACT
ABSTRACT BACKGROUND AND OBJECTIVES: Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter. CASE REPORT: A female patient in her sixties, physical status II (ASA), underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein. CONCLUSION: It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter.
RESUMO JUSTIFICATIVA E OBJETIVOS: A cateterização venosa inadvertida ocorre em aproximadamente 9% das anestesias peridurais lombares com introdução de cateter e caso não seja prontamente reconhecida pode trazer consequências fatais. O objetivo deste relato é descrever um caso de cateterização acidental do plexo venoso peridural e o seu registro por tomografia computadorizada com injeção de contraste pelo cateter. RELATO DE CASO: Paciente feminina, sexagenária, estado físico II (ASA), submetida à colecistectomia convencional sob anestesia geral balanceada e peridural com cateter para analgesia pós-operatória. Durante cirurgia houve suspeição clínica de cateterização acidental do plexo venoso peridural, por refluxo de sangue pelo cateter, fato confirmado pela administração de dose-teste pelo cateter. Feita tomografia computadorizada com injeção de contraste pelo cateter, após o termino da cirurgia. Observado todo o trajeto do contraste desde a pele até a veia ázigo, passando pelo plexo venoso peridural anterior, posterior e veia intervertebral. CONCLUSÃO: É possível a identificação do real posicionamento do cateter peridural, bem como o registro da cateterização acidental do plexo venoso peridural, por meio de tomografia computadorizada com injeção de contraste pelo cateter peridural.
Subject(s)
Humans , Female , Tomography, X-Ray Computed/methods , Epidural Space/diagnostic imaging , Anesthesia, General/adverse effects , Pain, Postoperative/drug therapy , Catheterization/methods , Cholecystectomy/methods , Contrast Media/administration & dosage , Anesthesia, Epidural/methods , Anesthesia, General/methods , Middle AgedABSTRACT
Objective To compare the clinical effect and adverse reactions of different concentrations of dezocine epidural anesthesia for cesarean section.Methods According to digital table,120 cases of elective cesarean section were randomly divided into 4 groups with 30 cases in each group, the group D1 was given with dezocine 2.5mg,the group D2 with dezocine 5mg,the group D3 with dezocine 10mg,the group M with morphine 2mg.All the drugs used in postoperative epidural analgesia after cesarean section.To observe resting pain and conduct the VAS scoring at postoperative 4,8,12,24h and record various adveme reactions.Results The VAS scores at postoperative 4,8,12h in the group D1 were lower than those in the D2,D3,M with statistical difference(all P0.05).The VAS scores at postoperative 8h in the group D3 were lower than those in the D2,D3,M with statistical difference(all P0.05).The incidence rates of nause-a and vomiting the group M were higher than that in the group D1,D2 and D3,showing statistical difference among them(P<0.05).Conclusion Appropriate concentrations of dezocine used in postoperative epidural analgesia after cesarean section has definite effect and less adverse reactions.
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ObjectiveTo explore the effect of two puncture during epidural cavity of lumbar subarachnoid space block anesthesia( referred to as combined spinal-epidural anesthesia).MethodsClincal dato of 50 cases of application,two puncture method combined spinal-epidural anesthesia for abdominal hysterectomy Electrocardiogram,heart rate (HR),oxygen saturation,blood pressure (BP) changes were analyed were retrospectively analyzed.using modified Bromage scoring method to determine motor nerve block and the quality of anesthesia.Results50 cases were successfully completed operation,without changing the mode of anesthesia.Motor nerve block anesthesia and quality excellent rate was 100％,the abdominal and cervical muscle relaxation quality excellent rate was 100％,analgesia was completely.No difficulty in breathing,chest tightness,headache,intraoperative fluid infusion about 1500ml,operation time ( 135.0 ± 4.5 ) min.48 patients hemodynamic status ( SpO2,HR,BP) remained stable,2 patients after anesthesia 10min appeared a drop in blood pressure,intravenous injection ephedrine 10mg returned to normal.Postoperative patients were cured,no neurological complications after anesthesia.ConclusionTwo puncture lumbar epidural combined anesthesia applied to hysterectomy had good,anesthesia effect,less complications,should be worthy of promotion.
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The materal-neonatal safety and materal stress response were evaluated during intratheeal anesthesia. Method: Forty-two parturients(ASA grade 1 )were randomly divided into two groups: spinal group (n=21), epidural group (n=21). 3 ml of 0.5% hyperbaric bupivacaine was given in spinal group; 12-15ml of 0.75 % bupivacaine was administrated in epidural group. Materal arterial samples were drawn before anesthesia,after anesthesia induction, after delivery and at the end of surgery; umbilieal venous samples were taken for measurements of blood catecholamine, sugar and lactate concentrations. Result; Compared with those before intrathecal blockade, plasma levels of catecholamine of two groups were significantly decreased in different periods during anesthesia (P0.05); there were not any significant differences between the two groups in neonate Apgar scores. Conclusion:Both of two techniques can inhibit stress response of parturients to cesarean sections and have no adverse effects to neonates when applied in proper management.