Furuya A, Matsukawa T, Ozaki M, Kumazawa T
Department of Anesthesia, Yamanashi Medical University, Japan.
J Clin Anesth. 1998 Aug;10(5):425-6. doi: 10.1016/s0952-8180(98)00038-5.
We report a case of interpleural misplacement of an epidural catheter possibly caused by inappropriate angle of the Tuohy needle. A 71-year-old man was scheduled for left lower lobectomy of the lung with general and epidural anesthesia. A 18-gauge Tuohy needle was introduced into the Th5-Th6 interspace with a right paramedian approach. The direction of the epidural needle was at an angle of about 30 degrees from the skin directed cephalad. The needle was advanced 8 cm from the skin, where loss-of-resistance feeling was evident, and an epidural catheter was easily inserted 5 cm beyond the needle tip. Administration of 7 ml of 1.5% lidocaine given 20 minutes before skin incision did not alter arterial blood pressure or heart rate. Thoracotomy was performed via the fifth intercostal space. The surgeon then found the epidural catheter to be in the left pleural cavity. The catheter was immediately withdrawn. It is, therefore, necessary to employ the appropriate angle of the Tuohy needle on attempting epidural anesthesia to avoid the complication that we experienced.
我们报告一例硬膜外导管置于胸膜间的病例，可能是由于Tuohy针角度不当所致。一名71岁男性计划行左肺下叶切除术，采用全身麻醉和硬膜外麻醉。使用18号Tuohy针经右侧旁正中入路进入T5 - T6间隙。硬膜外针的方向与皮肤呈约30度角，指向头侧。针从皮肤进针8 cm时，明显出现阻力消失感，硬膜外导管轻松地插入针尖超出5 cm。皮肤切开前20分钟给予7 ml 1.5%利多卡因，未改变动脉血压或心率。经第五肋间间隙进行开胸手术。随后外科医生发现硬膜外导管位于左胸腔内。导管立即被拔出。因此，在尝试硬膜外麻醉时，有必要采用合适的Tuohy针角度，以避免我们所经历的这种并发症。
