Masui. The Japanese journal of anesthesiology
-
We report a case of epidural hematoma in an elderly patient with normal coagulability and without difficulty in epidural catheterization. A 76-year-old man with a history of cervical myelopathy was scheduled for gastrojejunostomy under combined epidural and general anesthesia. He had normal bleeding time, coagulation test results, and platelet count. ⋯ On the second postoperative day, MRI of the spine demonstrated a hematoma-like lesion, and severe thoracic and lumbar spinal canal stenosis. Severe vertebral deformation, especially in cases of the elderly, is a potential risk for epidural hematoma after epidural catheterization, because a small hematoma may compress the spinal cord. A careful preoperative evaluation whether to perform epidural catheterization and postoperative observation are required for elderly patients with severe vertebral deformation.
-
Case Reports
[A Case of Epidural Hematoma after Removal of Epidural Catheter in a Patient with Coagulation Disorder].
A 75-year-old man with abdominal aortic aneurysm underwent Y-graft replacement under combination of general anesthesia and epidural anesthesia. Although we inserted an epidural catheter at first attempt from T11-12, nurse cut the epidural catheter accidently. We re-inserted from the same place. ⋯ After one hour, he could move leg but had numbness of the left leg. MRI revealed epidural hematoma from T8 to T10. Although the cause of epidural hematoma remains unclear, we should have proposed to check anticoagulant data when catheter was pulled out from epidural space.
-
A patient with medication resistant schizophrenia underwent modified electroconvulsive therapy (12 sessions). Propofol was chosen as a hypnotic agent and the adjustment of its dose and stimulus intensity was attempted. ⋯ This allowed to reach the seizure adequacy during the next and the four subsequent sessions. Although from the tenth session on, adequate seizures could no longer be induced (possibly due to the development of resistance to propofol), the patient's symptoms showed improvement after completion of all 12 sessions.