在困难放置后,从胸腔外围导管中延迟吸入脑脊液:一个案例报告
Daniel A Arnaut1, Daniel Ohlhausen2, Hamed Sadeghipour2
1Anesthesiology and Critical Care, Saint Louis University School of Medicine, St. Louis, USA.
Cureus
|August 27, 2024
概括
在外周导管安置过程中意外的长腔穿孔可能会危及患者的安全. 这一案例凸显了无意的下关节沟通的风险,可能导致危险的脊柱阻塞.
科学领域:
- 麻醉学 麻醉学
- 神经外科 神经外科
- 胃肠病学 胃肠病学
背景情况:
- 外周止痛药通常用于腹部外科手术中的术后疼痛管理.
- 克罗恩病患者在麻醉和手术期间可能会出现独特的挑战.
- 意外的硬膜穿孔是外周导管安置的已知并发症.
研究的目的:
- 在多次持续刺穿后,报告疑似下大脑下导管的情况.
- 强调在外围注射器放置期间警监测和吸入技术的重要性.
- 讨论与无意的长膜穿刺和下大脑沟通相关的潜在风险.
主要方法:
- 一名69岁的克罗恩病患者接受了开放式骨髓切除术.
- 进行了多次试图插入胸腔外周导管的尝试,导致了硬膜刺穿.
- 麻醉后的外周导管的诱导吸收揭示了脑脊髓液,促使其被移除.
主要成果:
- 在T10-11和T11-12的两个初步试图进行外周外注的尝试导致了意外的硬膜穿孔.
- 在T9-10的第三次尝试最初被认为是成功的,负吸收和测试剂量.
- 在连接之前随后的吸入产生了葡萄糖阳性液体,表明了脑下关节下部位.
结论:
- 意外的硬膜穿刺可以增加与子关节空间无意沟通的风险.
- 这种并发症可能导致意想不到的高或全脊柱阻塞,并可能导致危及生命的后果.
- 仔细吸入和监测至关重要,以防止在外周导管之后发生严重的不良事件.
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