Sujets)
Humains , Anesthésie de conduction/méthodes , Anticoagulants/administration et posologie , Guides de bonnes pratiques cliniques comme sujet , Anesthésie de conduction/effets indésirables , Anti-inflammatoires non stéroïdiens/administration et posologie , Anti-inflammatoires non stéroïdiens/effets indésirables , Anticoagulants/effets indésirables , Hématome épidural rachidien/épidémiologie , Hématome épidural rachidien/étiologie , Sécurité des patients , Antiagrégants plaquettaires/administration et posologie , Antiagrégants plaquettaires/effets indésirables , Facteurs de risqueRésumé
Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI) of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552). Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.
Sujets)
Analgésie péridurale/effets indésirables , Anesthésie péridurale/effets indésirables , Procédures de chirurgie cardiaque , Cathétérisme/effets indésirables , Hématome épidural rachidien/étiologie , Humains , Appréciation des risquesRésumé
El hematoma epidural espinal es una complicación poco frecuente de la hemofilia. En la literatura han sido descritos algunos casos principalmente en la población pediátrica. El cuadro clínico del hematoma epidural espinal es bien conocido; sin embargo, la etiología de este plantea un reto médico. El tratamiento consiste en la descompresión quirúrgica, aunque últimamente se han planteado algunos casos de resolución espontánea cuando el cuadro neurológico es leve o tiene tendencia a la mejoría. El manejo de la hemofilia por lo general consiste en el reemplazo del factor deficiente de la coagulación. Reportamos el caso de un paciente masculino de 17 años de edad manejado en nuestro servicio de neurocirugía.
Sujets)
Humains , Adolescent , Femelle , Hématome épidural rachidien/complications , Hématome épidural rachidien/diagnostic , Hématome épidural rachidien/étiologie , Hématome épidural rachidien , Hémophilie A/complications , Spectroscopie par résonance magnétique , Syndrome de compression médullaire , Tomodensitométrie hélicoïdaleRésumé
O hematoma extradural espinhal espontâneo é considerado raro. Tem sido associado com hipertensão arterial e coagulopatias. O exame de escolha para diagnóstico é a ressonância nuclear magnética.O tratamento de escolha é drenagem cirúrgica do hematoma. O prognóstico está relacionado com a etiologia, intervalo entre icto e diagnóstico e o grau de déficits neurológicos. Os autores relatam um caso de hematoma extradural espinhal espontâneo, localizado na região torácica, com quadro de choque medular, sendo submetido a tratamento cirúrgico, que evoluiu para óbito.
The spontaneous spinal extradural hematoma is rare. It has been associated with arterial hypertension and coagulopaties. Magnetic resonance is the first choice for neuroimaging diagnosis. The surgical drainage of the hematoma is the best treatment. Prognosis is related to etiology, interval between ictus and diagnosis and degree of neurological deficits. The authors report a case of spontaneous spinal extradural hematoma, located in thoracic region, with medullar shock syndrome, that was submitted tosurgical treatment but died for non neurological complications.