Slow-onset subdural hematoma, evolving into paraplegia, after attempted spinal anesthesia– a case report

Cabitza, Paolo; Parrini, M.

doi:10.3109/17453679808999276

Cited by 4 publications

(1 citation statement)

References 16 publications

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“…Vor allem die Blasenfunktion muss vor der Entlassung überprüft werden. Der Patient muss darauf hingewiesen werden, dass er sich bei radikulären Beschwerden sofort wieder in ärztliche Behandlung begeben muss, um eine Raumforderung im Spinalkanal, etwa durch ein Hämatom oder später durch einen Abszess, auszuschließen [4,7].…”

Section: Regionalanästhesieunclassified

Ambulantes Operieren - Forderungen des Anästhesisten

Schaffer¹

2005

Zentralbl Chir

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The requirements of the anaesthetist regarding ambulatory surgery correspond to those in surgical procedures in hospital. This applies especially to the examination of the patients prior to anaesthesia. Anamnesis and physical examination are more important than radiological or laboratory examinations. According to jurisdiction in ambulatory surgery a shorter period of time between the declaration of consent and the operation is allowed. However, the patient must be guaranteed an adequate period of time for consideration. Since regional anaesthesia involves more organization and requires more time, general anaesthesia with short-acting drugs should be preferred. In observance to the recommendations of anaesthesiological associations and institutions both personnel and technical equipment should meet hospital standards. In day case surgery especially postoperative care must be well planned. This contains the prevention of postoperative nausea or vomiting and a sufficient postoperative analgesia.

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Section: Regionalanästhesieunclassified

Ambulantes Operieren - Forderungen des Anästhesisten

Schaffer¹

2005

Zentralbl Chir

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Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors

Lagerkranser

2017

Scandinavian Journal of Pain

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AbstractBackgroundBleeding into the vertebral canal causing a spinal haematoma (SH) is a rare but serious complication to central neuraxial blocks (CNB). Of all serious complications to CNBs such as meningitis, abscess, cardiovascular collapse, and nerve injury, neurological injury associated with SH has the worst prognosis for permanent harm. Around the turn of the millennium, the first guidelines were published that aimed to reduce the risk of this complication. These guidelines are based on known risk factors for SH, rather than evidence from randomised, controlled trials (RCTs). RCTs, and therefore meta-analysis of RCTs, are not appropriate for identifying rare events. Analysing published case reports of rare complications may at least reveal risk factors and can thereby improve management of CNBs. The aims of the present review were to analyse case reports of SH after CNBs published between 1994 and 2015, and compare these with previous reviews of case reports.MethodsMEDLINE and EMBASE were used for identifying case reports published in English, German, or Scandinavian languages, using appropriate search terms. Reference lists were also scrutinised for case reports. Twenty different variables from each case were specifically searched for and filled out on an Excel spreadsheet, and incidences were calculated using the number of informative reports as denominator for each variable.ResultsAltogether 166 case reports on spinal haematoma after CNB published during the years between 1994 and 2015 were collected. The annual number of case reports published during this period almost trebled compared with the two preceding decades. This trend continued even after the first guidelines on safe practice of CNBs appeared around year 2000, although more cases complied with such guidelines during the second half of the observation period (2005–2015) than during the first half. Three types of risk factors dominated:(1)Patient-related risk factors such as haemostatic and spinal disorders, (2) CNB-procedure-related risks such as complicated block, (3) Drug-related risks, i.e. medication with antihaemostatic drugs. Conclusions and implicationsThe annual number of published cases of spinal haematoma after central neuraxial blocks increased during the last two decades (1994–2015) compared to previous decades. Case reports on elderly women account for this increase.Antihaemostatic drugs, heparins in particular, are still major risk factors for developing post-CNB spinal bleedings. Other risk factors are haemostatic and spinal disorders and complicated blocks, especially “bloody taps”, whereas multiple attempts do not seem to increase the risk of bleeding. In a large number of cases, no risk factor was reported. Guidelines issued around the turn of the century do not seem to have affected the number of published reports. In most cases, guidelines were followed, especially during the second half of the study period. Thus, although guidelines reduce the risk of a post-CNB spinal haematoma, and should be strictly adhered to in every single case, they are no guarantee against such bleedings to occur.

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Neuraxial blocks and spinal haematoma: Review of 166 cases published 1994 – 2015. Part 2: diagnosis, treatment, and outcome

Lagerkranser

Lindquist

2017

Scandinavian Journal of Pain

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AbstractBackgroundBleeding into the vertebral canal causing a spinal haematoma (SH) is a rare but serious complication to central neuraxial blocks (CNB). Of all serious complications to CNBs, neurological injury associated with SH has the worst prognosis. Around the turn of the millennium, the first guidelines aiming to reduce the risk of this complication were published. These guidelines are based on known risk factors for SH, rather than evidence from randomized, controlled trials (RCTs). RCTs, and hence meta-analysis of RCTs, are not appropriate for identifying rare events. Analysing data from a significant number of published case reports of rare complications may reveal risk factors and patterns undetectable in reports on occasional cases, and can thereby help to improve management of CNBs. The aims of the present review were to analyse case reports of SH after CNBs published between 1994 and 2015 with regard to diagnosis, treatment, and outcome of SH after CNB.MethodsMEDLINE and EMBASE were utilized to find case reports published in English, German, or Scandinavian languages between 1994 and end of 2015, using appropriate search terms. Reference lists were also scrutinized for case reports. We documented initial and worst symptoms and signs of SH, diagnostic methods, treatment, and outcome of the SH. We calculated occurrences in per cent using the number of informative reports as denominator.ResultsOne hundred and sixty-six case reports on spinal hematomas after CNB published during the years between 1994 and 2015 were identified. Eighty per cent of the patients had severe neurological symptoms (paresis or paralysis). When compared over time, outcomes have improved significantly. Among patients subjected to surgical evacuation of the hematoma, outcomes were best if surgery was performed within 12 hours from the firstsign of motor dysfunction. However, even patients operated after more than 24 hours had relatively favourable outcomes. Whereas the outcomes after surgical evacuation of the epidural haematomas were quite satisfactory, only one of the operations for subdural haematoma (SSDH) resulted in a favourable outcome.Conclusions and implicationsSuspicion of a spinal hematoma calls for the consultation of an orthopaedic or neurological surgeon without delay. MRI is the recommended diagnostic tool. Surgical evacuation within 12 h from the first sign of motor dysfunction seems to lead to the best outcome, although many patients operated as late as after more than 24 hours did regain full motor function. Despite the poor prognosis after surgical evacuation of SSDH, the outcomes after post-CNB spinal haematoma in general have improved significantly over time.

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Slow-onset subdural hematoma, evolving into paraplegia, after attempted spinal anesthesia– a case report

Cited by 4 publications

References 16 publications

Ambulantes Operieren - Forderungen des Anästhesisten

Ambulantes Operieren - Forderungen des Anästhesisten

Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors

Neuraxial blocks and spinal haematoma: Review of 166 cases published 1994 – 2015. Part 2: diagnosis, treatment, and outcome

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