Abstract
BackgroundSpontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. The potential for difficult airway management with the patient under general anesthesia is one of the major concerns that needs to be addressed to prevent further cord compression. Anesthetic management should also include measures to maintain the mean arterial pressure to improve spinal cord perfusion. Furthermore, spine surgery in pregnant patients needs special consideration in terms of positioning and in the postoperative period.Case presentationWe present a case of a 35-year-old white woman at 21 weeks of gestation with a spontaneous cervical epidural hematoma. Fiberoptic bronchoscope-guided nasal intubation was a safe option to ensure a higher rate of successful endotracheal intubation while minimizing the risk of aggravating the injury. Her care posed other multiples challenges that required a multidisciplinary team approach.ConclusionsThe case of our patient serves as a reminder of this rare condition and its implications regarding anesthesia.
Highlights
Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage
The case of our patient serves as a reminder of this rare condition and its implications regarding anesthesia
Spontaneous cervical epidural hematoma (SCEH) during pregnancy is a rare condition; only ten cases have been reported in the literature to date
Summary
Spontaneous cervical epidural hematoma (SCEH) during pregnancy is a rare condition; only ten cases have been reported in the literature to date. Case presentation A 35-year-old white woman (weight 75 kg, height 160 cm), gravida 3 para 2, presented to our hospital at 21 weeks of gestation with paraplegia She had no significant medical or anesthetic history; in particular, she had no history of trauma, and she had not been taking aspirin or anticoagulants. After explanation of the anesthesia plan, the patient verbalized understanding and consented to undergo awake fiberoptic intubation Her American Society of Anesthesiologists Physical Status classification was I, her Mallampati classification was I, and she had a good mouth opening. The patient was continuously monitored for another 24 hours in the intensive care unit, and the postoperative period remained uneventful. She was transferred to the rehabilitation department where she underwent physical therapy. After 1 month, power had improved to grade 4 in her left leg and to grade 3 in her right leg, and she was able to move her arms freely
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