Case Report – Accidental Epidural Catheter Breakage and Its Management

Aim: Epidural anaesthesia which is preferred in most of the prolonged and painful procedures can be dreadful when the catheter breaks inside. In this case report we report accidental breakage of epidural catheter and its successful management. Presentation of Case: 47 year old male patient was posted for arthroscopic Anterior cruciate ligament (ACL) and Posterior Cruciate Ligament (PCL) repair under spinal and epidural anesthesia. Epidural catheter got sheared while securing it. It was managed by surgical removal to avoid further complications. Discussion: There are different causes for epidural catheter breakage including technical error and manufacture error. Catheter should be checked for any manufacturing defect or kinking. If there is resistant while inserting the catheter careful removal of catheter along with the needle should be performed to avoid breakage of catheter. Conclusion: Epidural catheter breakage can be disastrous for any anaesthesiologist, so it is important to be vigilant while securing epidural catheter. If accidentally epidural catheter is retained it should be discussed with the patient and surgeons, and it is either removed since it is a foreign body or if left in situ. Serial follow-up for any neurological symptoms should be done.

MANAGEMENT OF ANESTHESIA ON PATIENTS WHO WALK IN SESAROUS SECTION WITH ARTERITICAL TAKAYASU DISEASE

Takayasu Arteritis Disease (TA) is a chronic inflammatory, progressive, and idiopathic disease causes narrowing, obstruction and aneurysms in systemic arterial and pulmonary artery, which mainly attacks the aorta and its branches. During pregnancy, these patients should be given special attention, in connection with any complications that may occur. Case is a woman 32 years 38 weeks pregnant with TA disease with changes in several branches of the aorta since thirteen years ago. During pregnancy there are no complaints, and now she went to the hospital with 37-38 weeks gestation. Caesarean section has been done with regional anesthesia - epidural. Local anesthesia is administered by titration with the hope of sensory blockade obtained gradually. After procedure patient had observation in the recovery room and hemodynamic was stable then moved to ward. Conclusion of the case is some complications can affect pregnancy in patients with TA. In pre anesthetic evaluation should be done carefully, treatment of complications and anesthetic planning are essential. Maintenance of perfusion is a major concern for patients and neuraxial blocks can be used without harming the mother and fetus. In patients with complications of TA was still compensated, monitoring during the procedure the same as routinely used. Provision of continuous epidural anesthesia with titration to maintain hemodynamic stability and allows monitoring of cerebral perfusion through the levels of consciousness. To avoid hypoperfusion or postoperative complications of hypertensive patients should be monitored closely for 24 hours.

Use and costs of pain management in cesarian section

Aim.To study the use of drugs for pain management for cesarean section and their cost on time and the first day after surgery. Methods.A retrospective analysis of 117anesthesia cards and childbirth histories of women after a cesarean section was performed. We analyzed drug therapy aimed at reducing pain during 1day after cesarean section and performed a comparative analysis of the cost of drugs used in spinal and epidural anesthesia. Results.Regional methods of anesthesia, epidural and spinal, were used in 95% of all cases. Spinal anesthesia was performed in 77women, epidural in 34women. The frequency of prescribing opioid analgesics was higher with spinal anesthesia compared with epidural: trimeperidine (intramuscular) was used in 62(83%) of 77patients for spinal anesthesia and 1(3%) of 34 for epidural anesthesia (p0.05). There were no differences in the use of ketoprofen in the postoperative period with epidural and spinal anesthesia. The total cost of medicines used to control pain during and on the 1st day after surgery, with epidural anesthesia, was almost 10times higher than that of spinal anesthesia: 938 and 98rubles, respectively. Conclusion.To control pain during cesarean section, in addition to local anesthetics, trimeperidine was used more often with spinal than epidural anesthesia; in the postoperative period, ketoprofen and trimeperidine were used with the equal frequency with greater use of ropivacaine with epidural anesthesia through a stored catheter; this has caused a higher cost of pain management during and in the first day after cesarean section with epidural anesthesia.

To the mechanisms for the prevention of postoperative thromboembolic complications using regional methods of anesthesia

The article presents data on the mechanisms of development of vascular thrombosis, in particular, thromboembolic complications: 1. endothelial inyury or endothelial dysfunction; 2. slowing the flow of blood and its stagnation; 3. violation of the coagulation and anticoagulation blood systems. In accordance with paragraphs 1–3 the effects of regional anesthesia – epidural anesthesia and spinal anesthesia on the prevention of postoperative thromboembolic complications are considered.

ANESTHESIOLOGICAL MANAGEMENT OF FETOSCOPIC LASER COAGULATION OF PLACENTAL ANASTOMOSES IN TWIN-TO-TWIN TRANSFUSION SYNDROME

In this study we presented the analysis of regional anesthesia (epidural and spinal) effectiveness in 72 fetoscopic laser coagulation (FLC) of placental anastomoses, performed in Saint Petersburg Maternity hospital № 17. In 2008 FLC was performed under epidural anesthesia and average time of procedure was 120 minutes, in 2017 according the rising surgical experience the time of procedure reduced to 33 (23–37.5) minutes, that allowed start to use spinal anesthesia. Conclusions: regional methods (epidural and spinal) manage adequate level of anesthesia. Rising surgical experience and reducing the time of procedure to 33 (23–37.5) minutes allowed to use spinal anesthesia successfully. In 29.2 % of cases of regional anesthesia intraoperative arterial hypotension was observed but was successfully corrected by moderate vasopressors doses. No other anesthesiological maternal complications were observed, which confirming safety of regional anesthesia in fetoscopic laser coagulation of placental anastomoses.