scholarly journals Management of a ruptured epidural catheter, an anesthesiologist's dilemma: a case report

2020 ◽  
Vol 9 (1) ◽  
pp. 282
Author(s):  
Rodrigo A. Mendoza-Aceves ◽  
Rodrigo Banegas-Ruiz ◽  
Francisco F. Gómez-Mendoza ◽  
Rigoberto R. Román-Hernández ◽  
Jesica A. Aguirre-Ramírez ◽  
...  
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Epidural Catheter ◽  
Epidural Anesthesia ◽  
Diabetic Foot ◽  
Epidural Block ◽  
Anesthetic Technique ◽  
Safe Procedure ◽  
Catheter Tip ◽  
Broken Needle

Epidural anesthesia is a widely used anesthetic technique in lower extremity surgeries although it is a relatively safe procedure, it can have complications, such as rupture of the epidural catheter. This is a 69-year-old male patient with a diagnosis of Wagner IV diabetic foot is presented, which was scheduled for left supracondylar amputation in which after epidural block, retention of the catheter tip in the epidural space at level L2-L3 was seen, so hemi laminectomy was performed in a second surgical stage in L2 and removal of the epidural catheter. Ideally a broken needle should be removed as soon as possible.

Correlation between the Distribution of Contrast Medium and the Extent of Blockade during Epidural Anesthesia

2004 ◽  
Vol 100 (6) ◽  
pp. 1504-1510 ◽  
Author(s):  
Masataka Yokoyama ◽  
Motohiko Hanazaki ◽  
Hiromi Fujii ◽  
Satoshi Mizobuchi ◽  
Hideki Nakatsuka ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Epidural Catheter ◽  
Epidural Anesthesia ◽  
Individual Variation ◽  
Catheter Position ◽  
Catheter Tip ◽  
The Mean ◽  
Tip Position ◽  
Analgesic Block ◽  
Position Group

Background If the epidural spread of contrast medium can be well correlated with the spread of local anesthetics, epidurography can predict the dermatomal distribution of the anesthetic block. The authors evaluated the relation between radiographic and analgesic spread. Methods An epidural catheter was inserted in 90 patients, and predicted catheter tip position was recorded. The analgesic area was determined by pinprick after a 5-ml injection of 1.5% lidocaine, and epidurography was performed after a 5-ml injection of 240 mg I/ml iotrolan. Patients were assigned to three groups according to catheter tip position (group C: C-T4; group T: T5-T10; group L: T11-L), and patterns of spread were compared. In 16 of 90 subjects, radiographic and analgesic spread was further investigated after an additional 5-ml injection of iotrolan and lidocaine. Results The total radiographic spread correlated well with analgesic spread (right side: Y = 0.84 X + 0.16, r = 0.92, P < 0.01; left side: Y = 0.78 X + 0.45, r = 0.91, P < 0.01). The mean radiographic spread in the cephalad and caudal directions from the catheter tip also correlated well with mean analgesic spread (r = 0.97, P < 0.01, each direction). The mean distance between the predicted catheter tip and radiographically determined positions was 1.0 +/- 0.8 segments: the value in group T was significantly larger than that in groups C (P < 0.05) and L (P < 0.01). Although the correlation of radiographic spread with age was statistically significantly (r = 0.39, P < 0.01), great individual variation in spreading pattern was seen. In 16 subjects, mean radiographic spread correlated well with analgesic spread after 5- and 10-ml injections of iotrolan and lidocaine. Conclusions Epidurography is useful to indicate epidural catheter position and can help to predict the exact dermatomal distribution of analgesic block.

Spinal Abscess after Epidural Catheter Insertion: A Case Report

2014 ◽  
Vol 4 (1_suppl) ◽  
pp. s-0034-1376728-s-0034-1376728
Author(s):  
T. Velnar ◽  
G. Bunc ◽  
J. Ravnik
Keyword(s):  
Case Report ◽  
Epidural Catheter ◽  
Catheter Insertion ◽  
Spinal Abscess

CT Demonstration of the Extensive Extension of the Emphysematous Gangrene of the Lower Extremity Extending tothe Body: A Case Report

1996 ◽  
Vol 35 (2) ◽  
pp. 241
Author(s):  
Hak Soo Lee ◽  
Hyun Chul Rhim ◽  
Yong Soo Kim ◽  
Soon Young Song ◽  
Byung Hee Koh ◽  
...  
Keyword(s):  
Case Report ◽  
Lower Extremity

Acute Dystonia after a Single Dose of Intravenous Metoclopramide during Elective Cesarean Section: A Case Report.

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Danielle Levin
Keyword(s):  
Single Dose ◽  
Case Report ◽  
Cesarean Section ◽  
Epidural Anesthesia ◽  
Elective Cesarean Section ◽  
Single Administration ◽  
Dystonic Reaction ◽  
Elective Cesarean ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

We would like to present the first report of severe acute dystonic reaction after a single administration of metoclopramide during cesarean section under combined spinal-epidural anesthesia.  During elective cesarean section, a 30-year-old female vomited four times and was treated with 10mg intravenous metoclopramide and 8mg intravenous ondansetron.  Nausea subsided with the antiemetic treatment, but two minutes later, patient had rapid eye blinking, uncontrollable head movement, and became unresponsive.  Bolus of 50mg intravenous diphenhydramine resolved the acute dystonic symptoms within seconds.  Patient was again oriented times three, with no recollection of symptoms, and remained symptom free for the rest of admission. 

Anesthesia in Carvajal syndrome; the first case report

2020 ◽  
Vol 24 (1) ◽  
pp. 105-107
Author(s):  
Sedighe Shahhosseini ◽  
Reza Aminnejad ◽  
Amir Shafa ◽  
Mehrdad Memarzade
Keyword(s):  
Intensive Care ◽  
Case Report ◽  
Surgical Resection ◽  
Genetic Disorder ◽  
Anesthetic Technique ◽  
Close Monitoring ◽  
Anesthesia Management ◽  
Rare Genetic Disorder ◽  
First Case ◽  
Anesthetic Considerations

Carvajal syndrome is a rare genetic disorder. Patients reporting for surgery pose some difficulties in anesthesia management. In this case report we present the case of a 12-year-old boy, who was a known case of Carvajal syndrome, referred for surgical resection of perianal condyloma. Close monitoring of hemodynamic status is the mainstay of anesthetic considerations in such patients. As in any other challenging scenario, it should be kept in mind that ‘there is no safest anesthetic agent, nor the safest anesthetic technique; there is only the safest anesthesiologist’. Citation: Shahhosseini S, Aminnejad R, Shafa A, Memarzadeh M. Anesthesia in Carvajal syndrome; the first case report. Anaesth pain intensive care 2020;24(1):___ DOI: https://doi.org/10.35975/apic.v24i1.

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