ABSTRACT
Epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. We report the case of a woman in whom this complication presented after knee replacement surgery under combined neuraxial anesthesia. No adverse events occurred during surgery. In the early postoperative period thromboembolic prophylaxis and continuous perfusion of ropivacaine were started through the epidural catheter. Lumbar pain along with sensorimotor alterations in the lower limbs developed on the first day after surgery. Epidural hematoma was suspected and the perfusion of local anesthetic was suspended. A computed tomography scan confirmed the presence of a hematoma with poorly defined margins. The patient was transferred to another hospital for dorsolumbar magnetic resonance, which revealed an extensive hematoma. Surgery was ruled out in favor of conservative treatment. Neurological symptoms resolved slowly over the following days and the patient was discharged partially recovered 51 days after surgery and recovery was complete within 6 postoperative months. We discuss the prevalence, etiology, and treatment of neuraxial hematoma related to local or regional anesthesia.
Subject(s)
Anesthesia, Epidural , Anticoagulants/adverse effects , Arthroplasty, Replacement, Knee , Enoxaparin/adverse effects , Fecal Incontinence/etiology , Hematoma, Epidural, Spinal/etiology , Hematoma, Subdural, Spinal/etiology , Hemiplegia/etiology , Postoperative Complications/etiology , Psychomotor Agitation/etiology , Punctures/adverse effects , Urinary Incontinence/etiology , Aged , Amides , Analgesia, Epidural , Anti-Inflammatory Agents/therapeutic use , Back Pain/etiology , Bupivacaine , Dexamethasone/therapeutic use , Emergencies , Female , Fentanyl , Hematoma, Epidural, Spinal/chemically induced , Hematoma, Epidural, Spinal/diagnostic imaging , Hematoma, Epidural, Spinal/drug therapy , Hematoma, Subdural, Spinal/chemically induced , Hematoma, Subdural, Spinal/diagnostic imaging , Hematoma, Subdural, Spinal/drug therapy , Humans , Magnetic Resonance Imaging , Postoperative Complications/prevention & control , Ropivacaine , Subarachnoid Space , Thrombosis/prevention & control , Tomography, X-Ray ComputedABSTRACT
El hematoma epidural es una complicación neurológica infrecuente pero grave de la anestesia neuroaxial. Presentamos el caso de una mujer que fue intervenida de implante de prótesis de cadera y desarrolló esta complicación. Se realizó una anestesia combinada neuroaxial. La intervención transcurrió sin incidencias. En el postoperatorio se inició profilaxis tromboembólica y perfusión continua de ropivacaína por catéter epidural. El primer día del postoperatorio, apareció dolor lumbar y alteración sensitivomotora en miembros inferiores. Con la sospecha de hematoma epidural, se suspendió perfusión de anestésico local. Se realizó una tomografía computerizada (TC) que confirmó la existencia de un hematoma con límites mal definidos. Fue trasladada a centro de referencia para realización de resonancia magnética (RM) dorsolumbar, evidenciando un hematoma extenso. Rechazada para intervención quirúrgica se trató de forma conservadora. La evolución neurológica fue lentamente favorable en los días siguientes, siendo dada de alta a los 51 días de la cirugía con recuperación parcial. A los 6 meses de la intervención la recuperación era completa. Se comentan la prevalencia, la etiología y el tratamiento del hematoma neuroaxial asociado a anestesia locorregional
Epidural hematoma is a rare but serious neurological complication of neuraxial anesthesia. We report the case of a woman in whom this complication presented after hip replacement surgery under combined neuraxial anesthesia. No adverse events occurred during surgery. In the early postoperative period thromboembolic prophylaxis and continuous perfusion of ropivacaine were started through the epidural catheter. Lumbar pain along with sensorimotor alterations in the lower limbs developed on the first day after surgery. Epidural hematoma was suspected and the perfusion of local anesthetic was suspended. A computed tomography scan confirmed the presence of a hematoma with poorly defined margins. The patient was transferred to another hospital for dorsolumbar magnetic resonance, which revealed an extensive hematoma. Surgery was ruled out in favor of conservative treatment. Neurological symptoms resolved slowly over the following days and the patient was discharged partially recovered 51 days after surgery and recovery was complete within 6 postoperative months. We discuss the prevalence, etiology, and treatment of neuraxial hematoma related to local or regional anesthesia
Subject(s)
Female , Aged , Humans , Anesthesia, Epidural , Anticoagulants/adverse effects , Arthroplasty, Replacement, Knee , Enoxaparin/adverse effects , Fecal Incontinence/etiology , Hematoma, Subdural/etiology , Hemiplegia/etiology , Postoperative Complications/etiology , Psychomotor Agitation/etiology , Punctures/adverse effects , Urinary Incontinence/etiology , Amides , Analgesia, Epidural , Anti-Inflammatory Agents/therapeutic use , Back Pain/etiology , Bupivacaine , Dexamethasone/therapeutic use , Emergencies , Fentanyl , Hematoma, Subdural/chemically induced , Hematoma, Subdural/drug therapy , Hematoma, Subdural , Magnetic Resonance Imaging , Postoperative Complications/prevention & control , Subarachnoid Space , Thrombosis/prevention & control , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To determine possible differences between the Schirmer test and the tear break up time (BUT) in relation to the etiology and severity of the dry eye syndrome. METHODS: We present a prospective study of 206 eyes in 106 patients (38 males and 68 females). Both the Schirmer test and BUT were performed on all of them. We divided the patients into ten etiologic groups according to the Madrid triple classification of dry eye etiology and into four groups according to clinical severity. RESULTS: Both the Schirmer test and BUT results decrease according to the severity of symptoms and we found significant differences between clinical groups. In regard to etiology, we found lower values of the Schirmer test especially in immunological, senile and traumatic dry eye groups. BUT measures were lower in immunological, inflammatory and tantalic dry eye groups. CONCLUSIONS: Although we found differences between Schirmer test results and BUT values according to dry eye etiology, these differences were only statistically significant between the immunological group and the other groups. Differences between etiological groups decreased with worsening of the illness due to a general affectation of the lacrimal glands.
Subject(s)
Dry Eye Syndromes/diagnosis , Dry Eye Syndromes/etiology , Diagnostic Techniques, Ophthalmological , Female , Humans , Male , Prospective Studies , Severity of Illness IndexABSTRACT
Objetivo: Determinar si existen diferencias en el test de Schirmer y el tiempo de ruptura lagrimal (BUT) en relación con la etiología y gravedad del síndrome de sequedad ocular.Métodos: Realizamos un estudio prospectivo sobre 206 ojos pertenecientes a 106 pacientes (38 hombres y 68 mujeres), donde se mide el test de Schirmer y el BUT. La población estudiada se dividió en diez grupos etiológicos, según los criterios de la clasificación de Madrid, y en cuatro grupos atendiendo a parámetros de gravedad clínica.Resultados: Los valores del test de Schirmer y BUT disminuyeron con la gravedad del cuadro clínico, existiendo diferencias significativas entre los cuatro grupos clínicos. En cuanto a criterios etiológicos, el test de Schirmer se afectó sobre todo en ojo seco inmunopático, etario y traumático, mientras que el BUT lo hizo en ojo seco inmunopático, inflamatorio y tantálico.Conclusiones: Aunque existen diferencias en cuanto a los valores del test de Schirner y BUT según la etiología responsable del síndrome de sequedad ocular, éstas son sólo estadísticamente significativas entre el grupo de ojo seco inmunopático y el resto. Las diferencias entre grupos etiológicos tienden a disminuir con la gravedad del cuadro clínico como consecuencia de la afectación global de las distintas dacrioglándulas que se produce en casos de ojo seco moderado y grave (AU)
Purpose: To determine possible differences between the Schirmer test and the tear break up time (BUT) in relation to the etiology and severity of the dry eye syndrome. Methods: We present a prospective study of 206 eyes in 106 patients (38 males and 68 females). Both the Schirmer test and BUT were performed on all of them. We divided the patients into ten etiologic groups according to the Madrid triple classification of dry eye etiology and into four groups according to clinical severity. Results: Both the Schirmer test and BUT results decrease according to the severity of symptoms and we found significant differences between clinical groups. In regard to etiology, we found lower values of the Schirmer test especially in immunological, senile and traumatic dry eye groups. BUT measures were lower in immunological, inflammatory and tantalic dry eye groups. Conclusions: Although we found differences between Schirmer test results and BUT values according to dry eye etiology, these differences were only statistically significant between the immunological group and the other groups. Differences between etiological groups decreased with worsening of the illness due to a general affectation of the lacrimal glands (AU)
