SummaryWe report the occurrence of an epidural haematoma after the removal of a lumbar epidural catheter, which had been inserted 2 days previously for surgery to revise a thrombosed femoralpopliteal graft. Pre-operatively the patient received intravenous heparin by infusion, but this was stopped 7 h prior to epidural insertion. Coagulation studies were normal. The epidural catheter insertion was unremarkable. Postoperatively, the patient received a continuous epidural infusion of fentanyl (3 mg.ml À1 ) and bupivacaine (0.0625%), in addition to systemic anticoagulant therapy with heparin. On the second postoperative day, the patient was noted to have developed bilateral leg weakness (following transfer to another department for Doppler studies). The epidural catheter was inadvertently removed while the patient was anticoagulated and paraparesis developed overnight. After a significant delay, an epidural haematoma was diagnosed and treated by decompressive laminectomy. At operation an epidural haematoma extending posteriorly from T 12 to L 3 was removed.Keywords Anaesthetic techniques, regional; epidural. Surgery; vascular. Complications; epidural haematoma. ...................................................................................... Correspondence to: Dr R. W. H. Skilton Accepted: 12 February 1998 Spinal bleeding resulting in permanent paraplegia is a 'worst case' scenario following epidural catheter insertion. Although the incidence of epidural bleeding may be as high as 10% following catheter placement, the incidence of significant spinal bleeding (paraplegia requiring laminectomy) has been estimated at 1: 1000 000 [1] in patients without clinically apparent coagulation disorders. Only 61 cases of epidural haematoma associated with regional anaesthesia were reported in the world literature up to 1993, with 32 involving the use of an epidural catheter [2]. We report a further case and discuss the aetiological factors involved. Case historyA 75-year-old, 78-kg male was transferred from a private hospital for further management of his ischaemic right leg. Three months previously he had surgery to repeat coronary artery bypass grafts following an episode of unstable angina and congestive cardiac failure. He had a markedly dilated left ventricle with an ejection fraction of 15% and had required an intra-aortic balloon pump to allow weaning from cardiopulmonary bypass. The balloon pump had been inserted into the right femoral artery and the right leg was noted to be cool and mottled in the recovery room. The balloon pump was removed and a femoral embolectomy performed with some improvement. This was followed 2 months later by a femoral-distal bypass procedure but this had to be revised due to thrombosis. A further thrombosis of the new superficial femoral artery graft resolved after treatment with urokinase and systemic heparinisation. However, the peroneal supply remained impaired and he developed ischaemic ulceration on his foot. The patient was transferred to our tertiary centre for evaluation a...

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Hypothesis: Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU).

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