Anesthesiology Department: Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Unidade de Medicina Hiperbárica, Hospital Pedro Hispano, Matosinhos, Portugal.
Diving Hyperb Med. 2022 Mar 31;52(1):54-57. doi: 10.28920/dhm52.1.54-57.
Pneumorrhachis is a rare clinical entity that is usually asymptomatic. Previous reports have associated such events with epidural insertion using a loss of resistance (LOR) to air technique. This report describes a case of symptomatic epidural pneumorrhachis following epidural anaesthesia using LOR to saline.
A 32-year-old American Society of Anesthesiologists (ASA) Classification II female patient was admitted for unplanned caesarean section. Epidural anaesthesia was performed at the L3-4 space using LOR to saline. The procedure, including delivery of the neonate, was uneventful. In the recovery room, a local anaesthetic infusion via an elastomeric pump (infusion 'balloon') was started. Two hours after initiation of the infusion the patient complained of motor blockade, so it was stopped. Two hours later she remained paraparetic, and a neurologist assessment was required. A computed tomography scan showed epidural pneumorrhachis at the L2-3 level. The patient was referred for emergent hyperbaric oxygen treatment (US Navy Treatment Table 5) and following one session the patient recovered completely.
Anaesthetists should be aware of this rare complication, which is easily overlooked. Hyperbaric oxygen treatment is a first line treatment for gas-associated lesions with neurological impairment. Timely referral is essential to prevent irreversible deficits.
气脊是一种罕见的临床病症，通常无症状。先前的报告将此类事件与使用硬膜外腔“落空感”（LOR）向空气注气技术相关联。本报告描述了一例使用 LOR 向生理盐水行硬膜外麻醉后出现症状性硬膜外气脊的病例。
一位 32 岁美国麻醉医师协会（ASA）分级 II 女性患者因择期剖宫产而入院。在 L3-4 间隙行硬膜外麻醉，使用 LOR 向生理盐水注气。该过程包括新生儿的娩出，过程顺利。在恢复室中，通过弹性泵（输注“球囊”）开始局部麻醉输注。输注开始后 2 小时，患者出现运动阻滞，因此停止输注。2 小时后，她仍存在截瘫，需要神经科医生评估。计算机断层扫描显示 L2-3 水平硬膜外气脊。患者被转介进行紧急高压氧治疗（美国海军治疗表 5），进行一次治疗后，患者完全康复。
麻醉医生应该意识到这种容易被忽视的罕见并发症。高压氧治疗是神经功能障碍相关气体性病变的一线治疗方法。及时转诊至关重要，以防止不可逆转的损伤。
