Paraplegia after combined general and epidural anesthesia: a case report

Neurological complications after epidural anesthesia performed for abdominal surgery are uncommon, but of important consequence with significant morbidity. Paraplegia is very rare and may be a result of multiple factors. We report a case of elective colectomy under combined general and epidural anesthesia for a carcinoma. An epidural infusion was used for intra-operative and post-operative analgesia. During induction of anesthesia, the patient was asystolic for a few seconds and during the first postoperative day, a hypotensive episode was registered. He then developed a sensory-motor deficit in the legs. A spinal cord infarction at the level of T10 extending to T2 was diagnosed with magnetic resonance imaging. The association of hypotension as a cause of spinal cord infarction is discussed. The factors that may have contributed to paraplegia and preventive neuroprotective strategies are reviewed.