Anestesia subdural após punção peridural: relato de dois casos

Abstract

Epidural anesthesia is a widely used procedure nowadays. Accidental subdural anesthesia after epidural puncture is an uncommon complication. This report aimed at describing two cases of subdural injection which coincidentally have happened in consecutive anesthesias induced by the same anesthesiologist.Case 1: Male patient, 41 years old, physical status ASA I, submitted to surgical ureteral calculi removal. Our choice was epidural anesthesia. Thirty minutes after beginning of induction, patient was communicative but sleepy with 100% SpO2, when he slowly began to show oxygen saturation decrease reaching 80% SpO2. Patient was unconscious with apnea and anisocoria. At this moment the diagnostic hypothesis was accidental subdural anesthesia. Patient was then intubated and maintained under mechanically controlled ventilation. After surgery, patient was referred to the recovery room and was discharged 6 hours after without any neurological complications. Case 2: Female patient, 82 years old, physical status ASA II, submitted to surgical proximal femur fracture fixation. Our choice in this case was continuous epidural anesthesia. Similar to the previous case, 30 minutes after she began to show SpO2 decrease, reaching 90%. Patient was uncons- cious with anisocoria, however without apnea. We decided to maintain the patient under constant surveillance and intubation was considered unnecessary. Our diagnostic hypothesis in this case was also accidental subdural anesthesia. At surgery completion patient was referred to the recovery room and was discharged 4 hours after without any neurological complication.Accidental subdural anesthesia is a very uncommon complication. The diagnostic hypothesis, in our cases, was limited to clinical data. There are several subdural blockade complications, but most of the times they are easily managed, provided they are promptly diagnosed and treated.