Fischer F, Helms O, Hentz J-G, Steib A
Service d'anesthésie-réanimation, hôpitaux universitaires de Strasbourg, 1 place de l'Hôpital, Strasbourg, France.
Ann Fr Anesth Reanim. 2011 Feb;30(2):153-5. doi: 10.1016/j.annfar.2010.11.023. Epub 2011 Feb 1.
We report a case of impossible injection into a thoracic epidural catheter associated with a difficult withdrawal of this catheter after its introduction on the T3-T4 level. Thanks to a gentle and continuous traction, the catheter was finally successfully removed without being broken, but presented a simple knot at 13mm from its end. No neurological complication was observed later on. This complication happened during the introduction of the catheter at the thoracic level where anatomic conditions are less favorable for this kind of complication to happen than at the lumbar level. We have been probably confronted with a catheter taking an abnormal direction due to an anatomic structure. This case shows us that knots in an epidural catheter are also possible on the high thoracic level and that its ascent within the epidural space must happen without any resistance.
我们报告了一例在T3 - T4水平置入胸段硬膜外导管后无法注入药物且导管难以拔出的病例。通过轻柔持续牵引，导管最终成功完整拔出，但在距其末端13毫米处出现一个简单的结。之后未观察到神经并发症。该并发症发生在胸段导管置入过程中，此处的解剖条件比腰段更不利于此类并发症的发生。我们可能遇到了因解剖结构导致导管走向异常的情况。该病例表明，胸段高位硬膜外导管也可能出现打结，且其在硬膜外间隙内上升时必须毫无阻力。
