Spinal epidural hematoma related to an epidural catheter in a cardiac surgery patient

被引：13

作者：

Bang, Jiyoun ^{[1
]}

Kim, Joung Uk ^{[1
]}

Lee, Yu Mi ^{[1
]}

Joh, Junghwa ^{[1
]}

An, Eun-Hye ^{[1
]}

Lee, Jae-young ^{[1
]}

Kim, Ji Yeon ^{[1
]}

Choi, In-cheol ^{[1
]}

机构：

[1] Univ Ulsan Coll Med, Asan Med Ctr, Dept Anesthesiol & Pain Med, 388-1,Pungnap 2 Dong, Seoul 138736, South Korea

来源：

KOREAN JOURNAL OF ANESTHESIOLOGY | 2011年 / 61卷 / 06期

关键词：

Analgesia; Epidural; Hematoma; Postoperative complications; Spinal;

D O I：

10.4097/kjae.2011.61.6.524

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

The addition of thoracic epidural anesthesia to general anesthesia during cardiac surgery may have a beneficial effect on clinical outcome. However, epidural catheter insertion in a patient anticoagulated with heparin may increase the risk of epidural hematoma. We report a case of epidural hematoma in a 55-year-old male patient who had a thoracic epidural placed under general anesthesia preceding uneventful mitral valve replacement and tricuspid valve annular plasty. During the immediate postoperative period and first postoperative day, prothrombin time (PT) and activate partial thromboplastin time (aPTT) were mildly prolonged. On the first postoperative day, he complained of motor weakness of the lower limbs and back pain. An immediate MRI of the spine was performed and it revealed an epidural hematoma at the T5-6 level. Rapid surgical decompression resulted in a recovery of his neurological abnormalities to near normal levels. Management and preventing strategies of epidural hematoma are discussed.

引用

页码：524 / 527

页数：4

共 13 条

[1]

Nygard E., Kofoed K.F., Freiberg J., Holm S., Aldershvile J., Eliasen K., Et al., Effects of high thoracic epidural analgesia on myocardial blood flow in patients with ischemic heart disease, Circulation, 111, pp. 2165-2170, (2005)

[2]

Vandermeulen E.P., van Aken H., Vermylen J., Anticoagulants and spinal-epidural anesthesia, Anesth Analg, 79, pp. 1165-1177, (1994)

[3]

Svircevic V., Nierich A.P., Moons K.G., Diephuis J.C., Ennema J.J., Brandon B.B.G.J., Et al., Thoracic epidural anesthesia for cardiac surgery: A randomized trial, Anesthesiology, 114, pp. 262-270, (2011)

[4]

Ballantyne J.C., Carr D.B., Deferranti S., Suarez T., Lau J., Chalmers T.C., Et al., The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-analyses of randomized, controlled trials, Anesth Analg, 86, pp. 598-612, (1998)

[5]

Svircevic V., van Dijk D., Nierich A.P., Passier M.P., Kalkman C.J., van der Heijden G.J., Et al., Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery, Anesthesiology, 114, pp. 271-282, (2011)

[6]

Chaney M.A., Intrathecal and epidural anesthesia and analgesia for cardiac surgery, Anesth Analg, 102, pp. 45-64, (2006)

[7]

Horlocker T.T., Wedel D.J., Rowlingson J.C., Enneking F.K., Kopp S.L., Benzon H.T., Et al., Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition), Reg Anesth Pain Med, 35, pp. 64-101, (2010)

[8]

Rosen D.A., Hawkinberry II. D.W., Rosen K.R., Gustafson R.A., Hogg J.P., Broadman L.M., An epidural hematoma in an adolescent patient after cardiac surgery, Anesth Analg, 98, pp. 966-969, (2004)

[9]

Lison S., Dietrich W., Braun S., Boehm J., Schuster T., Englhard A., Et al., Enhanced thrombin generation after cardiopulmonary bypass surgery, Anesth Analg, 112, pp. 37-45, (2011)

[10]

Ahn S.S., Song Y.J., Clinical experience and management of cervicothoracic epidural hematoma, J Korean Neurosurg Soc, 47, pp. 381-384, (2010)

← 1 2 →