Paraplegia following intracord injection during attempted epidural anesthesia under general anesthesia |
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| Affiliation: | 1. Department of Anaesthesia, McGill University, Montreal, Canada;2. Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, La Jolla, California, USA;1. Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan;2. Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Mito, Ibaraki, Japan;1. MG (Med), Delhi Area, C/o 56 APO, India;2. Associate Professor, Hamdard Institute of Medical Sciences & Research, New Delhi, India;3. Addl Director, Critical Care, Park Hospital, Gurgaon, India;4. Graded Specialist (Anaesthesia), 179 Military Hospital, C/o 99 APO, India;1. David Geffen School of Medicine at UCLA, Los Angeles, CA;2. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA;1. Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital, Singapore;2. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore |
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| Abstract: | Background and Objectives. A case of permanent paraplegia is reported following attempted epidural anesthesia for a total knee replacement in a 62-year-old woman with a history of lumbar laminectomy for a prolapsed intervertebral disc. Methods. Epidural puncture was attempted during general anesthesia and neuromuscular block. Results. After four unsuccessful attempts, an epidural catheter was inserted above the upper end of the laminectomy scar. Several episodes of arterial hypotension occurred intraoperative and postoperative. Operative blood loss was minimal, and no bone glue was used. The patient awoke paraparetic with a sensory level of anesthesia to T5 bilaterally. MRI revealed an air bubble in the cord at T10 and a region of increased T2-weighted signal in the anterior aspect of the spinal cord between T4 and T5, consistent with infarction. Conclusion. Standards of management are discussed in relation to this case. |
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