[CASE REPORT: PNEUMOCEPHALIA AFTER EPIDURAL ANESTHESIA FOR HIP REPLACEMENT SURGERY.]

Area of Science:

• Anesthesiology
• Neurology
• Radiology

Background:

• Lumbar epidural anesthesia is frequently employed for lower extremity orthopedic and trauma surgeries.
• Pneumocephalia, or air in the cranial cavity, is a rare but serious complication associated with neuraxial anesthesia.

Observation:

• A patient undergoing hip replacement surgery developed altered consciousness, progressing to coma, eight hours post-lumbar epidural anesthesia.
• Brain computed tomography (CT) confirmed the presence of pneumocephalia.

Findings:

• The patient's neurological deficits showed improvement with symptomatic treatment.
• Follow-up CT scans demonstrated resolution of the pneumocephalia by the 8th postoperative day.
• The patient was discharged on postoperative day 15, fully recovered.

Implications:

• This case underscores the potential for pneumocephalia following lumbar epidural anesthesia, necessitating prompt diagnosis and management.
• The 'inverted bottle' theory is proposed as the likely mechanism for air entry into the cranial vault.
• Awareness of this complication is crucial for anesthesiologists managing patients undergoing procedures requiring epidural anesthesia.