Subdural Anesthesia Research Articles

Epidural, Inadvertent Subdural, and Combined Epidural-Subdural Anesthesia in Lumbar Spine Surgery: A Retrospective Analysis.

This study aimed to categorize contrast media images associated with epidural, subdural, and combined epidural-subdural anesthesia in patients who had undergone fluoroscopy-guided epidural anesthesia using contrast media combined with monitored anesthesia care (MAC) targeted at deep sedation, incorporating capnography over 5 years. Additionally, a correlation was established between the anesthetic effects and radiographic findings according to the categorized imaging appearances. This study included 628 patients who underwent endoscopic, open, or fusion surgery under epidural anesthesia at Nanoori Hospital in Gangnam between March 2018 and September 2023. Fluoroscopy-guided epidural anesthesia using contrast media combined with MAC and capnography was used. The dataset included detailed radiographic imaging, nursing, and anesthesia records. Distinct patterns of anesthesia administration were observed, with 49%, 19.6%, and 31% of patients receiving epidural, subdural, and combined epidural-subdural anesthesia, respectively. The incidence and duration of motor block were significantly different among the three groups. Additionally, subdural anesthesia displayed a higher incidence of motor block and a prolonged motor deficit duration than epidural anesthesia. Fluoroscopic guidance using a contrast medium for epidural and subdural anesthesia ensures precise space identification and prevents serious anesthetic complications. Our findings suggest the potential to achieve stable anesthesia, particularly using subdural and combined epidural-subdural anesthesia.

Accidental subdural block after epidural anesthesia in obstetric patient: Case report

Background: Although often overlooked, subdural anesthesia is a relatively common complication. It can present with a wide range of symptoms, from unexpectedly high sensory and limited motor blocks to significant hemodynamic and respiratory effects.
 Case Presentation: This case report documents the labor and delivery of a 26-year-old primigravida at 40 weeks gestation who requested an epidural at 4 cm. A 500 ml lactated Ringer's solution bolus was initiated prior to the procedure and a Tuohy needle, size 18-gauge, was utilized to locate the epidural space. Following a negative aspiration and falling meniscus test, a bolus of 8 ml containing a combination of 0.2% ropivacaine with 2 mcg/ml fentanyl was administered, resulting in a brief drop in blood pressure, which responded to ephedrine. An epidural infusion of 0.2% ropivacaine with 2 mcg/ml fentanyl was then started and continued until the decision was made to perform a caesarean section due to lack of progress. Prior to surgery, the epidural was supplemented with 15 ml of 0.75% ropivacaine and 50 mcg of fentanyl. Following the successful delivery of a healthy baby, the patient reported difficulty breathing, and her oxygen saturation dropped to 90%. She was intubated without medication and later extubated after the completion of surgery. The epidural provided pain relief for six hours postoperatively and the patient recovered fully without any neurological deficits.
 Conclusion: The case report describes an epidural anesthesia that resulted in respiratory depression and unconsciousness without sympatholysis. The local anesthetic diffused into the dura- arachnoid interface, or the subdural space, which facilitated the movement of the anesthetic cephalad. However, the patient experienced complete neurological recovery. This case demonstrates the importance of careful monitoring and prompt intervention in the event of complications during epidural anesthesia.
 Keywords: subdural anesthesia, primigravida, ropivacaine, unconsciousness.

Spinal subdural hematoma and subdural anesthesia following combined spinal\u2013epidural anesthesia: a case report

BackgroundSubdural anesthesia and spinal subdural hematoma are rare complications of combined spinal-epidural anesthesia. We present a patient who developed both after multiple attempts to achieve combined spinal–epidural anesthesia.Case presentationA 21-year-old parturient, gravida 1, para 1, with twin pregnancy at gestational age 34+ 5 weeks underwent cesarean delivery. Routine combined spinal–epidural anesthesia was planned; however, no cerebrospinal fluid outflow was achieved after several attempts. Bupivacaine (2.5 mL) administered via a spinal needle only achieved asymmetric blockade of the lower extremities, reaching T12. Then, epidural administration of low-dose 2-chlorprocaine caused unexpected blockade above T2 as well as tinnitus, dyspnea, and inability to speak. The patient was intubated, and the twins were delivered. Ten minutes after the operation, the patient was awake with normal tidal volume. The endotracheal tube was removed, and she was transferred to the intensive care unit for further observation. Postoperative magnetic resonance imaging suggested a spinal subdural hematoma extending from T12 to the cauda equina. Sensory and motor function completely recovered 5 h after surgery. She denied headache, low back pain, or other neurologic deficit. The patient was discharged 6 days after surgery. One month later, repeat MRI was normal.ConclusionsAll anesthesiologists should be aware of the possibility of SSDH and subdural block when performing neuraxial anesthesia, especially in patients in whom puncture is difficult. Less traumatic methods of achieving anesthesia, such as epidural anesthesia, single-shot spinal anesthesia, or general anesthesia should be considered in these patients. Furthermore, vital signs and neurologic function should be closely monitored during and after surgery.

Comparison of the effects of epidural and spinal anesthesia on analgesia and blood gases in neonates born by natural vaginal delivery: A clinical trial study

Introduction: One of the concerns of painless deliveries is the safety of neonates. This clinical trial study aimed to compare the effects of epidural and spinal anesthesia on the mortality rate of neonates.
 Methods: This clinical trial was conducted in Hamadan Hospital in Iran. Ninety women, ages 18 to 45, were randomly assigned to receive epidural or subdural anesthesia. Using a checklist, the following were collected: demographic information, midwifery, hemodynamic status, mothers' pain intensity, and analyses of the baby's umbilical cord blood. The data were analyzed by SPSS version 16 for statistical analysis. Twenty-two of the patients with spinal anesthesia and epidural anesthesia were excluded from the study.
 Results: There was no significant difference between the two groups in terms of age, gestational age, parity, and severity of pain before or after anesthesia. The hemodynamic status of the mothers before and during the first postoperative period was in the normal range, except that in the spinal group, a decrease in systolic blood pressure was observed in normal range compared with the epidural anesthesia group. In blood gas analysis, the mean pH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3) did not show significant differences between the two groups (p > 0.05). The only complications were acidosis and epidural anesthesia.
 Conclusion: Based on the findings of the present study, both spinal and epidural opioids have no adverse effects on the health of neonates. However, both spinal and epidural opioid are preferred due to fewer changes in the hemodynamic changes in mothers and in umbilical cord blood gas.

Case report: Subdural anesthesia in the obstetric patient

IntroductionSubdural anesthesia is a relatively frequent complication though seldom recognized. It has a broad spectrum of presentations ranging from an unexpectedly high sensory block with limited motor block, to substantial hemodynamic and respiratory involvement. Case presentationA 22-year old woman undergoing cesarean section under epidural anesthesia with evidence of long-lasting higher than expected sensory block and respiratory distress. ConclusionNeuraxial anesthesia comprises a number of versatile and safe techniques, though not exempt from complications including subdural anesthesia. We should be aware of this possibility in our clinical practice, know the risk factors and the diagnostic criteria.

Informe de caso: anestesia subdural en la paciente obstétrica

IntroductionSubdural anesthesia is a relatively frequent complication though seldom recognized. It has a broad spectrum of presentations ranging from an unexpectedly high sensory block with limited motor block, to substantial hemodynamic and respiratory involvement. Case presentationA 22-year old woman undergoing cesarean section under epidural anesthesia with evidence of long-lasting higher than expected sensory block and respiratory distress. ConclusionNeuraxial anesthesia comprises a number of versatile and safe techniques, though not exempt from complications including subdural anesthesia. We should be aware of this possibility in our clinical practice, and know the risk factors and the diagnostic criteria.

Early and subacute inflammatory response and long-term survival after hip trauma and surgery

BackgroundHip fractures represent major source of morbidity in elderly patients. There is little evidence about the impact of inflammatory changes induced by hip trauma and surgery on long term survival. MethodsWe evaluated the prognostic significance of the surgery-related dynamics of white blood cell count (WBC), neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6) and soluble adhesion molecules (including P-selectin, E-selectin and VCAM) on survival in 104 consecutive patients with traumatic hip fractures recruited within the 2 years period. ResultsIn surviving patients, the minimum follow-up length was 48 and maximum 84 months (median 60 months). The mean age of the population was 80±9 years, 72% were women. The survival rates were 69%, 45% and 38% at one, three and five years of the follow-up, respectively. Baseline serum creatinine, older age and subdural anesthesia type were associated with worse survival. The acute inflammatory response failed to predict the long term survival. In contrast, elevated WBC and IL-6 as assessed 21 days after the surgery were associated with a significantly worse outcome. ConclusionThe survival of elderly patients undergoing the surgery for acute hip fracture is unfavorable. In contrast to previous reports, we did not confirm that acute inflammatory response to the surgery predicts the long-term survival. On the contrary, persistent elevation of WBC and IL-6 three weeks after the surgery indicates a poor outcome.

Intentional Subdural Anesthesia and the Early Onset of the Block

Intentional Subdural Anesthesia and the Early Onset of the Block

134. Accidental Subdural Anesthesia: A Complication of Epidural Analgesia for Labour Pain

134. Accidental Subdural Anesthesia: A Complication of Epidural Analgesia for Labour Pain

Hypertrophic Herpes Simplex Simulating Anal Neoplasia in AIDS Patients: Report of Five Cases

Five patients (4 males; mean age, 46.4 years) with painful verrucous perianal lesions caused by herpes simplex virus are described. All patients had had AIDS for a long time and were using highly active antiretroviral therapy. CD4+ counts ranged from 73 to 370/mm3. All lesions were submitted to resection under subdural anesthesia. Histologic examinations revealed epithelial hyperplasia and dense inflammatory process, composed mainly of lymphocytes and plasma cells, extended just to the hypodermis. Immunohistochemistry was positive for herpes simplex virus Type 2 in four patients and for herpes simplex virus Type 1 in one patient, and did not detect human papillomavirus antigens. Three patients had recurrences after 3, 10, and 12 months. Resection was performed on two patients; one had a new recurrence after three months. Oral acyclovir eliminated the lesion in the third patient. The analysis of our patients suggests that herpes simplex virus, Types 1 and 2, may cause verrucous lesions simulating neoplasia in patients with AIDS using antiretroviral therapy.

Massive Subdural or Intrathecal Anesthesia?

Massive Subdural or Intrathecal Anesthesia?

Rapid Onset of Massive Subdural Anesthesia

This case report describes the accidental placement of a lumbar labor epidural catheter into the subdural space resulting in the rapid onset of massive subdural anesthesia. A single-orifice open-ended catheter was accidentally placed in the lumbar subdural space. After a test dose of 3 mL 1.5% lidocaine with 15 microg of epinephrine and 2 minutes after a bolus of 5 mL of 0.25% bupivacaine, there was a rapid onset of massive subdural anesthesia with a loss of consciousness, respiratory arrest, and absent pulses. The subdural catheter placement was confirmed by injection of a contrast agent under fluoroscopy. Massive subdural anesthesia is a complication of epidural catheter placement and may have a rapid onset causing a loss of consciousness, respiratory arrest, and absent pulses.

Rapid Onset of Massive Subdural Anesthesia

Rapid Onset of Massive Subdural Anesthesia

Anestesia subdural após punção peridural: relato de dois casos

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.

Successful subdural anesthesia for cesarean section and postoperative pain management

Subdural catheterization is a well described, but uncommon complication of attempted epidural block. Aspiration of blood or cerebrospinal fluid and use of a test dose can help identify venous or subarachnoid catheter placement but do not rule out subdural catheter placement. An unexpected high level of sensory block with relative sparing of lower extremity motor function is a consistent feature of subdural block. This report describes the early identification of subdural placement of a catheter intended for the epidural space. We present radiologic confirmation of the catheter's location, and describe its use to provide successful anesthesia for cesarean section and postoperative analgesia.

Effects of neural blockade and general anesthesia on the laser-Doppler skin blood flow waves recorded from the finger or toe

Effects of neural blockade and general anesthesia on the basic wave (BW) and the reflex wave (RW) among the laser-Doppler (L-D) skin blood flow waves recorded on the finger or toe were studied in 2 volunteers and 42 patients. The BW was continuous, rhythmic and independent of respiratory movements. The RW, which was induced by a deep inspiration or a snapping sound, was a transient marked reduction in blood flow. The BW was almost flattened and the RW was no longer induced at the finger under complete wrist block ( n = 2), or under cervical or upper thoracic epidural anesthesia extended caudally over T 7 ( n = 2). On the other hand, the BW was still detected with reducing frequency and the RW could be provoked with one exception at the finger on the side with a sympathetic ganglion block at the C 6 vertebral level ( n = 14). The BW and RW at the toe were retained under lumbar subdural anesthesia ( n = 6) as well. However, under the combination of lumbar subdural anesthesia and lower thoracic epidural anesthesia extending rostrally over T 4 ( n = 6), both the BW and the RW disappeared at the toe. In the course of deepening nitrous oxide/enflurane anesthesia ( n = 10), the BW gradually reduced in frequency until it was almost flattened, and it became difficult to provoke the RW. L-D flowmetry of the finger or toe could be a useful clinical measure for detecting the presence or absence of sympathetic function controlling cutaneous vasomotion.

Subdural hematoma and spinal anesthesia

Subdural hematoma and spinal anesthesia