Continuous spinal anaesthesia (CSA) is a cardio-stable technique used in high-risk patients undergoing surgery. However, this technique appeared to decline over the last decades due concerns of complications that arise from using this technique, such as post-dural puncture headaches and neurological deficits. We report two cases of elderly patients, one at high cardiac risk and one with dementia and multiple comorbidities, under CSA for orthopaedic surgery with no reported complications. CSA is an adequeate anaesthetic technique with a low failure rate and complications. Proper technique should be taken into consideration to increase the success rate for this procedure.
In handling critically ill patients, central venous catheterization is a fundamental procedure. Incidence of pleural effusion and mediastinal haematoma following central venous placement is rare, with a rate between 0.17% and 1%. We report a frail elderly man who was started on parenteral nutrition administered by left internal jugular vein catheter post-emergency laparotomy surgery for a perforated duodenal ulcer. He developed bilateral chylothorax immediately on the first day of parenteral nutrition supplement. Contrast-enhanced computed tomography of the thorax as part of chylothorax workouts incidentally revealed anterior mediastinal haematoma in communication with the catheter tip, implying likely an iatrogenic injury. Rapid onset of chylothorax may indicate a thoracic duct injury and concurrent parenteral nutrition content leakage from the extravasated catheter. The anatomical connection between the pleural and mediastinal cavities has not been clearly illustrated in the literature. Bilateral chest drains were inserted and the catheter was removed at bedside without complications. Despite using ultrasound guidance, clinical methods and post-procedure chest X-ray, the catheter malposition was not detected before initiation of parenteral nutrition. The learning point is for the clinician to remain vigilant for potential catheter-related complications.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.