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[Diagnosis of accidental subdural block]
K Saitoh1, H Kasuda, Y Hirabayashi
1Department of Anesthesiology, Jichi Medical School, Tochigi.
Masui. the Japanese Journal of Anesthesiology
|February 1, 1995
Summary
Accidental subdural block, a rare complication of epidural anesthesia, can cause severe hypotension. Early suspicion via vital sign changes and X-ray confirmation are crucial for diagnosis.
Area of Science:
- Anesthesiology
- Neurosurgery
Background:
- Continuous epidural block is a common anesthetic technique.
- Accidental dural puncture can lead to complications.
Observation:
- A 47-year-old male developed severe hypotension during gastrectomy under anesthesia with continuous epidural block.
- Hypotension occurred despite small doses of mepivacaine, suggesting an unusual block spread.
Findings:
- Subdural block was suspected due to unexpected hypotension during surgery.
- Postoperative X-ray confirmed the presence of contrast media in the subdural space.
- Distinguishing subdural from epidural contrast spread on X-ray can be challenging.
Implications:
- Clinicians should suspect subdural block in cases of unexplained vital sign abnormalities during epidural anesthesia.
- Careful interpretation of X-ray images is essential for diagnosing subdural block.
- Awareness of this complication is important for patient safety during neuraxial anesthesia.