ABSTRACT
Epidural catheters can cause a number of rare, serious complications. The following case report describes a patient who received continuous epidural analgesia following radical cystectomy for bladder cancer Fifty-three days after the cystectomy, the patient underwent emergency surgery for a metastasis at the vertebral level where the epidural catheter had been inserted. A metastasis at the site of an epidural catheter which may be a direct complication of epidural analgesia, is a previously unreported event. Local, anatomical and pathological factors which may have led to the patient developing a metastasis at the epidural site are discussed.
Subject(s)
Analgesia, Epidural/adverse effects , Carcinoma, Small Cell/secondary , Epidural Neoplasms/secondary , Urinary Bladder Neoplasms/pathology , Analgesia, Epidural/instrumentation , Back Pain/etiology , Carcinoma, Small Cell/complications , Carcinoma, Small Cell/surgery , Epidural Neoplasms/complications , Epidural Neoplasms/surgery , Fatal Outcome , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Spine/pathologyABSTRACT
Normal functioning of the thyroid gland during surgery is important, but few data are available on the possible interactions between anesthesia and thyroid hormones. In two independent studies we examined the influence of different types of general anesthesia on the plasma levels of the thyroid hormones. They revealed an intraoperative increase of free thyroxine (fT4) and total thyroxine (tT4) in plasma to approximately 150% of preanesthesia levels when enflurane was used. No increase in thyroid-stimulating hormone (TSH) secretion was noted prior to this. The increase was not due to a quantitative change in the binding proteins. The plasma levels of fT4 and tT4 returned to normal postoperatively; however, no accompanying increase in plasma triiodothyronine levels was observed. Hence we assume the increase to be due to hormone release from thyroid and/or extrathyroidal stores--an intercompartmental shifting.