Bromage P R, Benumof J L
Department of Anaesthesia, McGill University, Montreal, Canada.
Reg Anesth Pain Med. 1998 Jan-Feb;23(1):104-7. doi: 10.1016/s1098-7339(98)90120-1.
A case of permanent paraplegia is reported following attempted epidural anesthesia for a total knee replacement in a 62-year-old woman with a history of lumbar laminectomy for a prolapsed intervertebral disc.
Epidural puncture was attempted during general anesthesia and neuromuscular block.
After four unsuccessful attempts, an epidural catheter was inserted above the upper end of the laminectomy scar. Several episodes of arterial hypotension occurred intraoperative and postoperative. Operative blood loss was minimal, and no bone glue was used. The patient awoke paraparetic with a sensory level of anesthesia to T5 bilaterally. MRI revealed an air bubble in the cord at T10 and a region of increased T2-weighted signal in the anterior aspect of the spinal cord between T4 and T5, consistent with infarction.
Standards of management are discussed in relation to this case.
报道一例62岁女性在全膝关节置换术时尝试硬膜外麻醉后发生永久性截瘫的病例，该女性有因腰椎间盘突出症行腰椎椎板切除术的病史。
在全身麻醉和神经肌肉阻滞期间尝试进行硬膜外穿刺。
经过四次穿刺失败后，在椎板切除疤痕上端上方插入了硬膜外导管。术中及术后发生了几次动脉低血压。手术失血极少，未使用骨水泥。患者苏醒时双下肢轻瘫，双侧麻醉感觉平面达T5。MRI显示T10脊髓内有一个气泡，T4至T5脊髓前部T2加权信号增强区域，符合梗死表现。
针对该病例讨论了管理标准。
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