ABSTRACT
The isolation of Mycoplasma hominis in cultured biopsy material from a subdural empyema is a very rare finding. Likewise, subdural empyema complicating epidural anesthesia is an uncommon event after cesarean delivery. We report the case of a 32-year-old patient who presented a throbbing headache when standing 48 hours after undergoing cesarean delivery under spinal anesthesia. On the fifth day after surgery, the headache worsened, fever developed, and an abscess was detected at the abdominal wall; antibiotic treatment was prescribed. When fever and headache persisted and abdominal infection had been ruled out, nuclear magnetic resonance imaging of the head revealed subdural empyema. Emergency surgery to drain pus was carried out twice. Mycoplasma hominis was isolated from a blood-agar culture of the exudate. The patient recovered fully after combined surgical and antibiotic treatment.
Subject(s)
Anesthesia, Epidural/adverse effects , Cesarean Section , Empyema, Subdural/etiology , Mycoplasma Infections/etiology , Mycoplasma hominis , Postoperative Complications/etiology , Adult , Empyema, Subdural/microbiology , Female , Humans , Postoperative Complications/microbiology , PregnancyABSTRACT
El aislamiento de Mycoplasma hominis en un cultivo de material de un empiema subdural es un hallazgo muy infrecuente.Asimismo,es poco frecuente encontrar un empiema subdural como complicación de una anestesia epidural en una cesárea. Presentamos el caso clínico de una paciente de 32 años de edad que, tras ser sometida a cesárea bajo anestesia epidural, presentó a las 48 h del postoperatorio cefalea pulsátil en bipedestación. Al quinto día del postoperatorio presentó exacerbación de la cefalea y fiebre, evidenciándose además un absceso de pared abdominal que precisó tratamiento antibiótico. Ante la persistencia de la fiebre y la cefalea, y descartándose infección de origen abdominal, se practicó una resonancia magnética nuclear a nivel craneal que puso en evidencia la existencia un empiema subdural. Fue intervenida quirúrgicamente de urgencias en dos ocasiones para el drenaje del material purulento; poniendo de manifiesto el cultivo de dicho material, en un medio agar-sangre, la presencia de Mycoplasma hominis .Tras el tratamiento quirúrgico al que se asoció una antibioterapia adecuada se produjo la recuperación completa de la paciente
The isolation of Mycoplasma hominis in cultured biopsy material from a subdural empyema is a very rare finding. Likewise, subdural empyema complicating epi- dural anesthesia is an uncommon event after cesarean delivery. We report the case of a 32-year-old patient who pre- sented a throbbing headache when standing 48 hours after undergoing cesarean delivery under spinal anesthesia. On the fifth day after surgery, the headache worsened, fever developed, and an abscess was detected at the abdominal wall; antibiotic treatment was prescribed. When fever and headache persisted and abdominal infection had been ruled out, nuclear magnetic resonance imaging of the head revealed subdural empyema. Emergency surgery to drain pus was carried out twice. Mycoplasma hominis was isolated from a blood-agar culture of the exudate. The patient recovered fully after combined surgical and antibiotic treatment
Subject(s)
Female , Adult , Humans , Empyema, Subdural , Mycoplasma hominis , Cesarean Section/adverse effects , Obstetric Labor Complications , Anesthesia, Epidural , Infections , Postoperative Complications , Anti-Bacterial Agents/therapeutic use , Headache , Fever , Craniotomy , Tomography, X-Ray Computed , Magnetic Resonance Spectroscopy , BacteremiaABSTRACT
We report the case of a 54-year-old woman with cephalea of five months duration caused by a chronic subdural hematoma that appeared after epidural anesthesia and accidental dural puncture for bilateral saphenectomy. Computed tomography of the brain revealed an intracranial hematoma. After surgical evacuation, the patient's headaches resolved and she recovered fully. The appearance of cephalea after dural puncture is a relatively frequent complication of spinal anesthesia, but its persistence over time, as well as changes in its initial characteristics, should lead to a suspicion of life-threatening subdural hematoma.
Subject(s)
Anesthesia, Epidural/adverse effects , Dura Mater/injuries , Headache/etiology , Hematoma, Subdural/complications , Wounds, Penetrating/complications , Chronic Disease , Female , Hematoma, Subdural/etiology , Humans , Middle Aged , Wounds, Penetrating/etiologyABSTRACT
OBJECTIVE: To determine whether provision of an information sheet during the preanesthesia visit to the patient, and general recommendations for anesthesia, can change patients' image of the anesthesiologist. PATIENTS AND METHODS: Two groups of 100 patients each were studied before outpatient surgery. Group 1 (given no information) answered a questionnaire before an interview with the anesthesiologist. Group 2 (who were given information) answered the same questionnaire, which was accompanied by an information sheet explaining the nature of anesthesia, possible risks, operating room and postoperative procedures. RESULTS: In group 1,67% identified the anesthesiologist as a physician. In group 2, 99% (p < 0.05) were able to do so. In group 1, 48% believed that the anesthesiologist works under the surgeon's orders, while only 27% (p < 0.05) thought so in group 2. The chief of the postanesthesia intensive care unit was thought to be a member of the nursing staff by 48% in group 1, whereas 95% (p < 0.05) in group 2 identified the chief as an anesthesiologist. CONCLUSIONS: The image of anesthesiology and the anesthesiologist can be improved by systematically providing an information sheet to patients who are scheduled for presurgical study.
