Intravascular migration of a previously functioning epidural catheter

Jeon, Jooyeon; Yoon, Haesang; Kim, Myoung-Goo; Lee, Pil-Moo

doi:10.4097/kjae.2013.64.6.556

Cited by 6 publications

(5 citation statements)

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“…risk of intravascular bolus of infusates had the catheter migrated intravascularly, which has been described to occur with patient posture changes and movements [5]. Hence, we have recommended for the use of an MRI for diagnostic imaging instead, which could delineate location of catheter as well as potential epidural or spinal haematoma.…”

Section: Resultsmentioning

confidence: 99%

Untitled

2017

Int J Anesthetic Anesthesiol

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Epidural catheters that are commonly placed for anaesthesia or analgesia have a serious complication of migration. Besides intravascular local anaesthetic infusion which could lead to systemic toxicity, a subdural migration is often diagnosed late and presents with life-threatening outcomes noted either at post-mortem or requiring intensive care management. Albeit training and protocols for insertion, administering and management of epidurals have been established, not all complications can be mitigated. We present a case of an epidural catheter migration in a patient with timely detection and management without airway compromise with an analysis of the detection, diagnosis and management. Various methods for diagnosis have been described in the literature as we discuss the pros and cons of bedside and radiological investigations. A high index of suspicion and knowledge of potential problems in the management of patient with in-dwelling epidural catheters prove vital to avoid complications with catheter migration. Adequate training and availability of emergency contact details would expedite management in emergencies.location [1]. This could potentially be life-threatening from inadvertent administration of epidural drug dosages into the subdural space. We present a case report of a patient who had a timely detection of possible epidural catheter migration into the subdural space while on a local anaesthetic infusion. Case ReportA 77-year-old lady was admitted for an elective open abdominal hysterectomy and bilateral salpingo-oophorectomy and left radical nephrectomy for complex atypical hyperplasia of her endometrium and left kidney angiomyolipoma. Her other medical problems include hypertension, hypercholesterolaemia and gastro-oesophageal reflux disease. Her previous surgeries include a total knee replacement, tonsillectomy and excision to her breast cyst. Her body mass index was 34.1 kg/m 2 and pre-operative investigations were within acceptable limits for her surgery. Appropriate consent was taken for surgery, regional and general anaesthesia before arrival to theatre.An epidural was inserted pre-induction under aseptic conditions for post-operative analgesia in the sitting position under monitoring. A midline approach was used at T8/9 interspace with a standard 8 cm 16 G Tuohy needle, under local anesthesia (lignocaine 1%) in two attempts, guided by loss of resistance to saline and air respectively. The needle insertion depth was 7 cm with the catheter anchored at 10 cm at skin. A lignocaine 2% 3 ml epidural test dose was also given before starting the epidural infusion of bupivacaine 0.1% with 2 mcg/ ml fentanyl at 10 ml/h. Subsequently, a right internal CAse RepoRTCheck for updates

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Section: Resultsmentioning

confidence: 99%

Untitled

2017

Int J Anesthetic Anesthesiol

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“…5 Insiden migrasi kateter epidural pada ibu hamil lebih tinggi 15% dari pasien yang tidak hamil, hal ini dikarenakan dilatasi vena epidural yang signifikan. 6 Hal ini sejalan dengan penelitian lainnya, yang menyebutkan migrasi kateter epidural dua kali lebih sering pada pasien obstetrik. 7 ANATOMI Kolom Vertebra (Columna Vertebralis) Spinal tersusun atas tulang vertebral dan diskus fibrokartilago intervertebral.…”

Section: Definisiunclassified

“…persalinan dengan epidural, bisa meningkatkan resiko migrasi kateter epidural. 6,7 2. Volume obat Volume obat epidural juga ikut mempengaruhi tekanan ruang epidural.…”

Section: Gambar 4 Tempat Keluar Serabut Saraf Spinalisunclassified

“…Diantaranya aspirasi kateter epidural secara hati-hati, penggunaan test dose, dan pemberian dosis epidural secara terbagi. 6 Penggunaan test dose secara rutin tidak selalu dapat memastikan bahwa kateter berada di posisi yang tepat, akan tetapi setiap dosis mantanance yang diberikan harus selalu dianggap sebagai test dose yang diberikan secara inkremental. 4 Monitoring secara hati-hati setiap dosis epidural yang diberikan adalah suatu keharusan.…”

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Faktor-Faktor yang Mempengaruhi Migrasi Kateter Epidural

Purnomo

Rusman

2017

JAI b

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Currently, continuous epidural anesthesia was one of the regional anesthesia technique used on daily anesthesia practice. It could be used for single anesthesia on surgery, adjuvant of general anesthesia, pain management of post surgery and chronic pain management of malignancy. One of the problems faced on continuous epidural procedure was migration of epidural catheter out from epidural space. In the beginning catheter was placed on epidural space and confirmed by Loss of Resistance (LOR) technique, hanging drop, or by ultrasonography. Due to many factors, epidural catheter could migrate from the place that should be. This surely affected the effectivity of anesthesia from epidural technique itself, and became fatal if a certain amount of local anesthesia regiment entered to other spaces through the catheter which previously moved to subarachnoidea space, intravascular, or subdural space. Migration of catheter could be caused by malposition on placement or patient's movement, and increased of epidural space pressure. Thus, it's important for anesthesiologist to know what factors that would increase the risk of epidural catheter migration and how to prevent and manage the complication that could happen. ABSTRAKEpidural kontinyu saat ini merupakan salah satu satu tekhnik regional anestesia yang mulai sering digunakan dalam praktek anesthesia sehari-hari. Dapat digunakan untuk anestesia tunggal dalam pembedahan, adjuvan anestesia umum, manajemen nyeri paska operasi serta menajemen nyeri kronis pada pasien keganasan. Salah satu permasalahan yang banyak dihadapi pada prosedur epidural kontinyu adalah kejadian migrasi kateter epidural keluar dari ruang epidural. Kateter pada awalnya telah berada di rongga epidural dan telah dikonfirmasi dengan teknik Loss of

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“…The epidural catheter migration could be into the epidural vein leading to local anaesthetic systemic toxicity or into the subarachnoid space causing total spinal anaesthesia when a local anaesthetic agent is injected [9]. A recent clinical modification of the combined spinal-epidural anaesthesia technique is epidural volume extension [10].…”

Section: Introductionmentioning

confidence: 99%

A Comparative Study on Influence of Epidural Volume Extension on the Block Characteristics of Subarachnoid Plain Bupivacaine for Lower Abdominal Surgeries

Aniobi

Ebirim²,

Tobin³

2022

JAMMR

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Background: Central neuraxial block is a common anaesthetic technique for lower abdominal surgeries. Epidural volume extension is a technique that involves the injection of saline into the epidural space immediately following intrathecal injection, after the institution of combined spinal-epidural anaesthesia. This technique has some advantages over general anaesthesia like a circumvention of laryngeal response to airway manipulation. It also provides an effective sensory and motor blockade. The aim of this study was to assess the influence of epidural volume extension on the block characteristics of subarachnoid plain bupivacaine administered for lower abdominal surgeries. Results: All the forty-two patients recruited completed the study. The mean time to request for the first analgesia was significantly longer in group Subarachnoid plus Epidural volume extension (SEVE) (208.63 + 84.14 minutes) than in group Subarachnoid (S) (148.95 ± 40.55 minutes), P= 0.02. The maximum median level of sensory block was significantly higher in the Subarachnoid plus Epidural volume extension (SEVE) group compared with the Subarachnoid (S) group and this was recorded at the 8th minute; T4 (T4-T6), and T5 (T5-T7), respectively. (P=0.01). The mean time to reach T6 sensory level was significantly less in group Subarachnoid plus Epidural volume extension (SEVE); 6.00 + 1.80 minutes compared with group Subarachnoid (S); 7.00 + 1.10minutes. (P=0.04). The systolic and diastolic blood pressure, mean arterial pressure, pulse rate and peripheral oxygen saturation recorded during the duration of surgery was within normal limits in both Subarachnoid (S) and Subarachnoid plus Epidural volume extension (SEVE)groups. There was no statistically significant difference between the two groups. The side effects recorded were hypotension and shivering. Hypotension occurred in 19.0% of patients in both groups, while shivering occurred in 9.5% in group Subarachnoid plus Epidural volume extension (SEVE) and 4.8% in group Subarachnoid (S) (P=0.575). Conclusion: This study showed that epidural volume extension when using intrathecal low dose plain bupivacaine for lower abdominal surgeries not only provided adequate sensory and motor block but also a prolongation of anaesthesia. The incidences of side effects noticed in both groups were low and similar. Therefore, this study underscores the relevance of epidural volume extension on the subarachnoid block characteristics.

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Intravascular migration of a previously functioning epidural catheter

Cited by 6 publications

References 6 publications

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Faktor-Faktor yang Mempengaruhi Migrasi Kateter Epidural

A Comparative Study on Influence of Epidural Volume Extension on the Block Characteristics of Subarachnoid Plain Bupivacaine for Lower Abdominal Surgeries

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