Arnaut Daniel A, Ohlhausen Daniel, Sadeghipour Hamed
Anesthesiology and Critical Care, Saint Louis University School of Medicine, St. Louis, USA.
Anesthesiology and Critical Care, SSM Health Saint Louis University Hospital, St. Louis, USA.
Cureus. 2024 Jul 27;16(7):e65519. doi: 10.7759/cureus.65519. eCollection 2024 Jul.
A 69-year-old female with Crohn's disease was admitted for open ileocecectomy with lysis of adhesions. The plan was to proceed with general endotracheal anesthesia and a thoracic epidural catheter for perioperative analgesia. Epidural access was attempted at the T10-11 and T11-12 interspaces, both of which resulted in accidental dural punctures. On the third attempt, the epidural catheter was inserted at the T9-10 interspace. Both the aspiration and test dose were negative. Thirty minutes later, after induction of general anesthesia, the catheter was again aspirated before the epidural pump was connected. Freely flowing, glucose-positive fluid was obtained, and the catheter was removed for the patient's safety. This case suggests that accidental dural puncture may be a risk factor for inappropriate communication with the subarachnoid space. This can be assumed to increase the risk of unanticipated high or total spinal block and its life-threatening sequelae.
一名69岁患有克罗恩病的女性因开放性回盲部切除术及粘连松解术入院。计划采用全身气管内麻醉并置入胸段硬膜外导管用于围手术期镇痛。尝试在T10 - 11和T11 - 12椎间隙进行硬膜外穿刺，均导致意外硬膜穿破。第三次尝试时，在T9 - 10椎间隙插入硬膜外导管。回抽和试验剂量均为阴性。30分钟后，全身麻醉诱导后，在连接硬膜外泵之前再次回抽导管。获得了自由流动、葡萄糖阳性的液体，为患者安全起见，拔除了导管。该病例提示意外硬膜穿破可能是与蛛网膜下腔不适当连通的一个危险因素。可以认为这会增加意外高位或全脊髓阻滞及其危及生命的后遗症的风险。
