RESUMEN
Epidural analgesia is commonly used for pain management during labor. Owing to the blind nature of the insertion of the catheters, they are prone to migration to various spaces intra-spinally, which may result in a multitude of complications. We present a case of a 32-year-old lady who was admitted with labor pain, and an epidural catheter was inserted for labor analgesia. Five hours after insertion, she developed sudden motor and sensory impairment suggestive of subarachnoid migration of the catheter. The diagnosis, management, and risks associated with delay in the identification of this potentially fatal complication are discussed.
RESUMEN
Background: Lumboperitoneal (LP) shunt placement is a good option for treating elderly patients with communicating normal pressure hydrocephalus (NPH) who are also on antiplatelet therapy following endovascular treatment of unruptured bilateral internal carotid artery aneurysms. Here, in an 80-year-old male with an LP shunt, the catheter was "pinched" between adjacent spinous processes, resulting in laceration of the catheter and intrathecal catheter migration. Case Description: An 80-year-old male was treated with a LP shunt for NPH 1 year after undergoing endovascular treatment of unruptured bilateral internal carotid artery aneurysms. The lumbar catheter was placed at the L2-3 level. Six months later, when he clinically deteriorated, the follow-up computed tomography showed recurrent ventricular enlargement. Further, studies additionally confirmed intrathecal migration of the lumbar catheter, warranting secondary ventriculoperitoneal shunt placement. Conclusion: Patients with LP shunts may develop lumbar catheter lacerations secondary to a "pinching" effect from adjacent spinous processes, resulting in intrathecal catheter migration.
RESUMEN
A 68 years old male patient was scheduled for open cholecystectomy and common bile duct exploration for gallstone and common bile duct stones with cholecystitis. With the patient in lateral decubitus position, a 17 G Tuohy needle was inserted into the epidural space via midline approach at the T10-11 interspace by using the loss of resistance technique. Then, an 18 G epidural catheter was inserted into the epidural space upward 5 cm for postoperative pain control without complications such as bleeding, paresthesia or CSF leakage. After the epidural catheterization, general anesthesia was induced. During the surgery, the aspiration test via the epidural catheter was done once more before connection of PCA device to the epidural catheter, and some clear fluid was found to be aspirated. Intrathecal migration of the epidural catheter was doubted and confirmed by a measurement of glucose level and the thiopental precipitation test. After the end of surgery, the epidural catheter was removed and the patient was discharged from the PACU 1 hour later without any complication or sequelae. We report a case of early detection of intrathecal migration of an epidural catheter by a measurement of glucose level and the thiopental precipitation test of the aspirated fluid.