Successful treatment of epidural anesthesia–induced severe pneumocephalus by hyperbaric oxygen therapy

Shih, Chi-Wei; Tsai, Shih‐Hung; Wang, Jen-Chun

doi:10.1016/j.ajem.2015.01.044

Cited by 9 publications

(16 citation statements)

References 10 publications

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“…The hyperbaric oxygen therapy treatment duration should be guided by clinical and radiographic evolution. In our case, only one treatment was needed to resolve the whole clinical picture, in line with previous reports [5,9].…”

Section: Discussionsupporting

confidence: 91%

“…Pneumocephalus is a rare complication of epidural catheterization, usually resulting in the accidental injection of air into the intrathecal space [ 1 , 5 ]. Although controversial, this epidural “air technique” is generally regarded as safer in case of an accidental dural puncture, though it may be associated with a higher rate of other complications [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Bed rest, head elevation, oxygen therapy, avoidance of Valsalva manoeuvres and cough is recommended [ 4 ]. In the more severe cases, hyperbaric oxygen therapy, although controversial, can be beneficial [ 3 , 5 , 9 ], especially in highly symptomatic patients, with multiple air bubbles on imaging or with hemodynamic compromise. The high concentration of provided oxygen replaces the nitrogen in the air bubbles, allowing its reabsorption [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pneumocephalus Following an Accidental Dural Puncture, Treated Using Hyperbaric Oxygen Therapy. A Case Report

Marino

Simões

Simas

et al. 2021

The Journal of Critical Care Medicine

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Introduction: Neuraxial techniques, including epidural anaesthesia, are often used for perioperative pain control and are generally safe. However, both transient, mild and even severe, life-threatening neurologic complications can occur. Case presentation: A seventy-eight-year-old man was admitted to the hospital for a radical nephrectomy plus transurethral resection due to kidney and bladder cancer. During the epidural exploration, an accidental dural puncture was noted. This was followed by the patient complaining of an intense headache. The epidural catheter was placed in a different location, and surgery was performed uneventfully. The patient presented with confusion, agitation, vertical nystagmus, vision loss, and paraparesis about two hours later. The epidural levobupivacaine and morphine infusion were stopped, followed by motor block resolution. A computerized head-tomography scan showed extra-axial multiple air spots involving the frontal and temporal lobes. Emergent hyperbaric oxygen therapy was commenced. After a single session, there was complete resolution of all symptoms and a marked reduction in the number and volume of the extra-axial air visible on the CT scan. Conclusions: Although rare, pneumocephalus is a well-recognized complication of a dural puncture. Its rapid recognition in a patient with new-onset neurological symptoms and early treatment with hyperbaric oxygen therapy allows rapid clinical and imaging resolution and an improved prognosis.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pneumocephalus Following an Accidental Dural Puncture, Treated Using Hyperbaric Oxygen Therapy. A Case Report

Marino

Simões

Simas

et al. 2021

The Journal of Critical Care Medicine

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“…OHB se ha mencionado antes, como una opción terapéutica para PC. (Shih, Tsai, Liao, Wang, & Hsu, 2015) se presenta un caso de una mujer de 36 años de edad con parada cardiorrespiratoria y coma profundo causado por la epidural PC inducida por la anestesia. Ella fue tratada con éxito con una sesión de TOHB de 120 minutos a 2,8 atm de presión absoluta con 100% de concentración de oxígenogen.…”

Section: Nuevo Tratamiento Sugeridounclassified

Tratamiento en pacientes con cefalea postpunción dural

Chica¹,

Saverio²,

Alcívar³

et al. 2019

RECIAMUC

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“…Shih et al [84] presented a case of a 36-year-old woman with cardiopulmonary arrest and deep coma caused by epidural anesthesia-induced PC. She was treated successfully with one session of HBOT of 120 minutes at 2.8 atm absolute pressure with 100% oxygen concentration.…”

Section: Suggested New Treatmentmentioning

confidence: 99%

Post Dural Puncture Headache—Review and Suggested New Treatment

Kracoff¹,

Kotlovker²

2016

OJAnes

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Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome; cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat postdural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle's law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.

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Successful treatment of epidural anesthesia–induced severe pneumocephalus by hyperbaric oxygen therapy

Cited by 9 publications

References 10 publications

Pneumocephalus Following an Accidental Dural Puncture, Treated Using Hyperbaric Oxygen Therapy. A Case Report

Pneumocephalus Following an Accidental Dural Puncture, Treated Using Hyperbaric Oxygen Therapy. A Case Report

Tratamiento en pacientes con cefalea postpunción dural

Post Dural Puncture Headache—Review and Suggested New Treatment

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