[Slight Damage to Epidural Catheter Equipped with Tuohy Needle at Time of Insertion Results in Embedded Remnant.]

It is known that a portion of an epidural catheter can remain embedded when the catheter is pulled back at the time of insertion or a longer length than required is used. We report a case in which an epi- dural catheter piece including a metal coil broke off and remained embedded at the time of withdrawal. Because of the presence of the coil, MRI could not be utilized, while CT scanning was useful to locate the remaining portion. Following surgical extraction, the embedded portion was thoroughly examined. The point of the catheter was cut sharply, which suggested that damage occurred without awareness of the anesthesi- ologist When a catheter breaks leaving a remnant surgical extraction should be considered based on appropriate examination findings.

[Study of background factors of cerebral hyperperfusion syndrome in the anesthetic management of carotid endarterectomy].

BACKGROUND: We conducted a retrospective study to evaluate background factors of cerebral hyperperfusion syndrome (CHS) in the anesthetic management of carotid endarterectomy (CEA) for carotid artery stenosis. METHODS: A total of 118 ASA 1-2 adult patients were allocated to one of two groups: Group A of 13 patients who developed CHS after CEA, and Group B of the remaining 105 patients. We weighed control percent ratio of somatosensory evoked potential (%SEP). The rate of carotid artery stenosis, stump pressure of internal carotid artery, %SEP internal carotid artery blood flow (ICF), and preoperative anesthetic problems were compared between the two groups. RESULTS: The rate of carotid artery stenosis in Group A was 85%, significantly higher than 74% of Group B. Stump pressure in Group A was 28 mmHg, significantly lower than 37 mmHg of Group B. %SEP was 67% of Group A, and 87% of Group B, respectively ICF in Group A was 7+ +/- 33 ml min(-1), which decreaced significantly compared with 78 +/- 34 ml min(-1) of Group B. CONCLUSIONS: We conclude that the patients with high rate of carotid artery stenosis, low stump pressure and low ICF have a high risk of developing CHS after CEA and careful attention should be required in the anesthetic management of CEA.