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因腰椎融合导致硬膜外注射意外失败的阴道子宫切除病例的麻醉管理

Anaesthetic management of a vaginal hysterectomy case with an unanticipated failure of epidural injection due to fused lumbar spine.

作者信息

Bajwa Sukhminder Jit Singh, Bajwa Sukhwinder Kaur, Kaur Jasbir, Singh Brig Amarjit, Prasad Seema

机构信息

Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India.

出版信息

Int J Appl Basic Med Res. 2011 Jan;1(1):57-9. doi: 10.4103/2229-516X.81984.

DOI:10.4103/2229-516X.81984
PMID:23776776
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3657956/
Abstract

Epidural anesthesia is one of the easier and safer techniques for lower abdominal surgery. It has a very high success rate in the experienced hands, and failure rates are minimal when it is administered by the experienced anesthesiologists. As it is a blind technique, failures can be encountered even by a senior anesthesiologist in many situations and one must analyze retrospectively the various causes responsible for such failures. We report a case of 45-year-old female, weighing 60 kg, who was scheduled for elective vaginal hysterectomy under regional anesthesia. Initial four to five attempts were unsuccessful in establishing the epidural block as the epidural injection encountered bony resistance each time, but subarachnoid block could be achieved with a 23 G spinal needle in the paramedian site of entry in the third attempt. Postoperatively, lumbar and cervical spine X-rays were done which revealed an isolated lumbar spine bony fusion. She was diagnosed as a rare case of isolated lumbar spine fusion without any involvement of cervical spine, other articular joints or any systemic manifestations of diseases like ankylosing spondylitis.

摘要

硬膜外麻醉是下腹部手术中较为简便且安全的技术之一。在经验丰富的医生手中,其成功率很高,由经验丰富的麻醉医生实施时失败率极低。由于这是一种盲探技术,即便资深麻醉医生在许多情况下也可能遭遇失败,必须对导致此类失败的各种原因进行回顾性分析。我们报告一例45岁、体重60公斤的女性患者,计划在区域麻醉下行择期阴道子宫切除术。最初进行了四五次尝试,每次硬膜外注射均遇到骨质阻力,未能成功建立硬膜外阻滞,但在第三次尝试时,于旁正中入路使用23G脊髓穿刺针成功实现了蛛网膜下腔阻滞。术后进行了腰椎和颈椎X线检查,结果显示为孤立性腰椎骨质融合。她被诊断为罕见的孤立性腰椎融合病例,未累及颈椎、其他关节或任何如强直性脊柱炎等疾病的全身表现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2b3/3657956/789b7ab517ad/IJABMR-1-57-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2b3/3657956/789b7ab517ad/IJABMR-1-57-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2b3/3657956/789b7ab517ad/IJABMR-1-57-g001.jpg

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