ABSTRACT
PURPOSE: We report the first case of abscess formation after combined spinal-epidural block (CSE). Penetration of the dura in CSE may constitute an additional risk of subarachnoid spread of bacteria when post-puncture epidural infection is present. CLINICAL FEATURES: The combination of a spinal and a continuous epidural block (CSE) using a needle through needle technique was used in a 72-yr-old man for reconstructive vascular surgery of the lower limb. On the fourth postoperative day the patient demonstrated back pain, fever, and exudation of pus from the CSE-puncture site. An epidural abscess was diagnosed by magnetic resonance imaging and subsequently an emergency hemiaminectomy was performed. Physical examination and surgery did not show evidence of bacterial spread into the subarachnoid space. CONCLUSION: Epidural abscess formation after CSE may increase the risk of bacterial spread into the subarachnoid space. In this case spontaneous exudation and surgical drainage of abscess material may have prevented intrathecal infection. Rapid diagnosis and treatment of an epidural abscess appears particularly essential after CSE to prevent neurological sequelae.
Subject(s)
Abscess/etiology , Anesthesia, Epidural/adverse effects , Anesthesia, Spinal/adverse effects , Aged , Humans , MaleABSTRACT
OBJECTIVE: To demonstrate the safety of autologous blood donation in an obstetric practice. METHODS: A total of 2350 pregnant patients were screened for an increased risk of peripartum bleeding. Excluding patients with contraindications, a total of 71 women participated in this autologous blood donation program. Blood was donated in the 35th and 37th weeks of pregnancy. RESULTS: No problems occurred in the course of blood donation. All newborns were found to be healthy; 41 of the 71 patients received peripartum autologous blood transfusions. Homologous blood was not given to any of the patients. CONCLUSION: Our experience demonstrates that autologous blood donation is a safe practice in the setting of obstetrics, when the indications and contraindications are considered. Further studies in larger patient populations are necessary to expand or restrict the indications for autologous transfusion in obstetrics.
