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硬膜外导管固定于后外侧硬膜外间隙:如何处理

Epidural catheter anchored in the posterior lateral epidural space: How to manage it.

作者信息

Costa C, Fonseca S, Guedes L, Leão A, Sousa A

机构信息

Servicio de Anestesia, Centro Hospitalar de São João, Porto, Portugal.

Servicio de Anestesia, Centro Hospitalar de São João, Porto, Portugal.

出版信息

Rev Esp Anestesiol Reanim (Engl Ed). 2018 Jan;65(1):59-61. doi: 10.1016/j.redar.2017.05.005. Epub 2017 Jul 27.

Abstract

We describe a case of an epidural catheter entrapment without knotting, kinking, shearing or breakage confirmed by CT scan and how to manage it. A patient was admitted for tibial fracture repair under general anesthesia with an epidural. At discharge day, multiple attempts to retrieve the catheter were made. Contrast CT scan showed the catheter anchored in the left posterior-lateral epidural space. Despite the absence of guidelines regarding epidural catheter entrapment, all the methods described in the literature were used. This is a rare complication and it may be associated with neurological and infectious complications. Radiologic imaging should be obtained to better characterize the catheters' position and plan removal. In this case, tension in the paraspinal muscles or in the supraspinous and intraspinous ligaments could explain the entrapment. General anesthesia with the non-depolarising muscle relaxant allowed muscles and ligaments to relax and we were able to retrieve the catheter intact.

摘要

我们描述了一例经CT扫描证实的无打结、扭结、剪切或断裂的硬膜外导管嵌顿病例及其处理方法。一名患者因胫骨骨折在全身麻醉下接受硬膜外麻醉进行修复手术。出院当天,多次尝试取出导管。CT造影扫描显示导管固定在左后外侧硬膜外间隙。尽管缺乏关于硬膜外导管嵌顿的指南,但我们采用了文献中描述的所有方法。这是一种罕见的并发症,可能与神经和感染并发症有关。应进行放射学成像以更好地确定导管位置并制定取出计划。在该病例中,椎旁肌肉或棘上韧带和棘间韧带的张力可能是导致嵌顿的原因。使用非去极化肌松剂的全身麻醉使肌肉和韧带松弛,我们得以完整取出导管。

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